Healthcare Provider Details

I. General information

NPI: 1275322075
Provider Name (Legal Business Name): VANESSA EATON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WASHBURN AVE
CAPITOLA CA
95010-3730
US

IV. Provider business mailing address

123 JORDAN ST
SANTA CRUZ CA
95060-3404
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-5660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: