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General NPI Number Information
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NPI Number | 1871703629
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Entity Type | Individual
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Provider Name | VICKI L.C. WEATHERFORD PH.D
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1010 SIR FRANCIS DRAKE BLVD STE 2
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City | KENTFIELD
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State | CA
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Zip | 94904-1444
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Country | US
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Telephone | 415-258-1723
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Fax | 415-258-1733
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Provider Business Mailing Address
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Address Line | 220 CASCADE DR
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City | FAIRFAX
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State | CA
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Zip | 94930-2133
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Country | US
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Telephone | 415-457-1312
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Fax | 415-258-1733
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10416
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License Number State | CA
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