Provider Demographics
NPI:1659833259
Name:ADVINCULA, LADY (ATR-BC, LPCC)
Entity type:Individual
Prefix:
First Name:LADY
Middle Name:
Last Name:ADVINCULA
Suffix:
Gender:F
Credentials:ATR-BC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11040 BOLLINGER CANYON RD STE E-439
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4969
Mailing Address - Country:US
Mailing Address - Phone:925-665-3668
Mailing Address - Fax:
Practice Address - Street 1:11040 BOLLINGER CANYON RD STE E-439
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4969
Practice Address - Country:US
Practice Address - Phone:925-665-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11808101YP2500X
CA17-136221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist