Healthcare Provider Details

I. General information

NPI: 1114113586
Provider Name (Legal Business Name): MARCIA ANN VASCONCELOS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCIA VASCONCELOS NEVILLE LMFT

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NORTH WELLS ROAD
SANTA PAULA CA
93060
US

IV. Provider business mailing address

PO BOX 2989
VENTURA CA
93002
US

V. Phone/Fax

Practice location:
  • Phone: 805-889-2578
  • Fax: 805-384-1555
Mailing address:
  • Phone: 805-889-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 40995
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMFC40995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: