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General NPI Number Information
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NPI Number | 1386114544
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Entity Type | Individual
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Provider Name | VANESSA ACOSTA MICHEL LCSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 3102 E HIGHLAND AVE
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City | PATTON
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State | CA
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Zip | 92369-7813
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Country | US
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Telephone | 909-672-6486
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Fax |
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Provider Business Mailing Address
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Address Line | 24839 CAPE COD ST
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5822
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Country | US
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Telephone | 909-850-6436
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 84611
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 105029
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License Number State | CA
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