Healthcare Provider Details

I. General information

NPI: 1821624016
Provider Name (Legal Business Name): VANESSA GRAY HERRERA CATC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA GRAY

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E FESLER ST
SANTA MARIA CA
93454-4404
US

IV. Provider business mailing address

115 E FESLER ST
SANTA MARIA CA
93454-4404
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-6597
  • Fax:
Mailing address:
  • Phone: 805-922-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13775-R
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2113775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: