Provider Demographics
NPI:1033416292
Name:GREEN, KRISTIN ANGELA VASQUEZ (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANGELA VASQUEZ
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:ANGELA
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10174 OLD GROVE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1648
Mailing Address - Country:US
Mailing Address - Phone:858-442-4480
Mailing Address - Fax:
Practice Address - Street 1:10174 OLD GROVE RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1648
Practice Address - Country:US
Practice Address - Phone:858-442-4480
Practice Address - Fax:866-561-3747
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88720106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist