Provider Demographics
NPI:1154521219
Name:VANCE, DEBORAH ANN (MFCC)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:VANCE
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SANDY WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8105
Mailing Address - Country:US
Mailing Address - Phone:530-542-2409
Mailing Address - Fax:530-542-2791
Practice Address - Street 1:3320 SANDY WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8105
Practice Address - Country:US
Practice Address - Phone:530-542-2409
Practice Address - Fax:530-542-2791
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist