Healthcare Provider Details

I. General information

NPI: 1861328171
Provider Name (Legal Business Name): SOUL CONNECTION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SHELBY DR
FAIRFIELD CA
94534-4345
US

IV. Provider business mailing address

1330 SHELBY DR
FAIRFIELD CA
94534-4345
US

V. Phone/Fax

Practice location:
  • Phone: 408-849-2669
  • Fax:
Mailing address:
  • Phone: 408-849-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: FABIANA VEGA
Title or Position: CEO
Credential: LMFT
Phone: 408-849-2669