Provider Demographics
NPI:1528679016
Name:VANNORTWICK, EMILY (LMFT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VANNORTWICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FESLER ST STE 208
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1946
Mailing Address - Country:US
Mailing Address - Phone:619-440-4211
Mailing Address - Fax:619-440-4205
Practice Address - Street 1:500 FESLER ST STE 208
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1946
Practice Address - Country:US
Practice Address - Phone:619-440-4211
Practice Address - Fax:619-440-4205
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801945340OtherNPI TYPE II