Provider Demographics
NPI:1962876490
Name:VERCELLI, MICHELLE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VERCELLI
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14664 RIO RANCHO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3854
Mailing Address - Country:US
Mailing Address - Phone:858-442-9174
Mailing Address - Fax:
Practice Address - Street 1:14664 RIO RANCHO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3854
Practice Address - Country:US
Practice Address - Phone:858-442-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist