Healthcare Provider Details

I. General information

NPI: 1023921608
Provider Name (Legal Business Name): LIAINA ANALISE CLAYTOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E MONTE VISTA AVE
VACAVILLE CA
95688-3009
US

IV. Provider business mailing address

2418 ARTISAN WAY
FAIRFIELD CA
94533-7129
US

V. Phone/Fax

Practice location:
  • Phone: 707-469-4640
  • Fax:
Mailing address:
  • Phone: 707-469-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: