Provider Demographics
NPI:1396247599
Name:ARRIVILLAGA, VANNESA RAQUEL (LMFT)
Entity type:Individual
Prefix:
First Name:VANNESA
Middle Name:RAQUEL
Last Name:ARRIVILLAGA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:VANNESA
Other - Middle Name:
Other - Last Name:ARRIVILLAGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3388 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2142
Mailing Address - Country:US
Mailing Address - Phone:909-791-6007
Mailing Address - Fax:
Practice Address - Street 1:11519 CARLISLE PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7233
Practice Address - Country:US
Practice Address - Phone:909-791-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99638106H00000X
CA139866106H00000X
CA149736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist