Provider Demographics
NPI:1861702235
Name:VERMILLION, YVONNE D (LMFT)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:D
Last Name:VERMILLION
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 1:549 FREDERICK STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062
Mailing Address - Country:US
Mailing Address - Phone:831-332-4632
Mailing Address - Fax:831-425-3945
Practice Address - Street 1:549 FREDERICK STREET
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2635
Practice Address - Country:US
Practice Address - Phone:831-332-4632
Practice Address - Fax:831-425-3945
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29324102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst