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General NPI Number Information
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NPI Number | 1053764514
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Entity Type | Individual
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Provider Name | VANESSA MARNEWECKE M.A.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 1085 I ST STE 203
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City | ARCATA
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State | CA
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Zip | 95521-5588
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Country | US
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Telephone | 707-600-3720
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4381
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City | ARCATA
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State | CA
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Zip | 95518-4381
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Country | US
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Telephone | 707-498-7623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 107352
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License Number State | CA
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