Healthcare Provider Details

I. General information

NPI: 1093313413
Provider Name (Legal Business Name): DANIELLE NICOLE BANKSON VACA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SHELL BLVD APT 104
FOSTER CITY CA
94404-2543
US

IV. Provider business mailing address

743 SHELL BLVD APT 104
FOSTER CITY CA
94404-2543
US

V. Phone/Fax

Practice location:
  • Phone: 650-477-4866
  • Fax:
Mailing address:
  • Phone: 650-477-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: