Provider Demographics
NPI:1902050685
Name:VACI, DANIEL RICHARD (LICENSED MFT #50418)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RICHARD
Last Name:VACI
Suffix:
Gender:M
Credentials:LICENSED MFT #50418
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 1/2 LOUISIANA STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116
Mailing Address - Country:US
Mailing Address - Phone:619-942-1776
Mailing Address - Fax:619-542-0332
Practice Address - Street 1:2231 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-942-1776
Practice Address - Fax:619-260-3054
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist