Healthcare Provider Details

I. General information

NPI: 1760026603
Provider Name (Legal Business Name): CATHERINE MARGETIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 13TH ST BLDG 7015
VANDENBERG AFB CA
93437-5221
US

IV. Provider business mailing address

2066 GREEN RIDGE CIR
LOMPOC CA
93436-3109
US

V. Phone/Fax

Practice location:
  • Phone: 805-605-4911
  • Fax:
Mailing address:
  • Phone: 210-218-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number700
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7326
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: