Healthcare Provider Details

I. General information

NPI: 1205141025
Provider Name (Legal Business Name): VACCARO CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 CLIFF SHADOWS PKWY STE. 150
LAS VEGAS NV
89129-5111
US

IV. Provider business mailing address

3425 CLIFF SHADOWS PKWY STE 150
LAS VEGAS NV
89129-5112
US

V. Phone/Fax

Practice location:
  • Phone: 702-845-9989
  • Fax:
Mailing address:
  • Phone: 702-845-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number01013
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01013
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01013
License Number StateNV

VIII. Authorized Official

Name: MS. ANITA THERESA VACCARO
Title or Position: OWNER
Credential: MA
Phone: 702-845-9989