Provider Demographics
NPI:1316196843
Name:VERGIE, AMY J (AMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:VERGIE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:2412 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7773
Mailing Address - Country:US
Mailing Address - Phone:916-778-6035
Mailing Address - Fax:
Practice Address - Street 1:2412 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7773
Practice Address - Country:US
Practice Address - Phone:916-778-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114694312OtherALLER COUNSELING & CONSULTING