Healthcare Provider Details

I. General information

NPI: 1275562555
Provider Name (Legal Business Name): AIMEE MICHELLE VADNAIS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 LOMAS SANTA FE DR STE 260
SOLANA BEACH CA
92075-1333
US

IV. Provider business mailing address

11784 CARMEL CREEK RD # B303
SAN DIEGO CA
92130-6751
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax: 858-509-4789
Mailing address:
  • Phone: 619-846-4686
  • Fax: 858-793-9562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 39973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: