Provider Demographics
NPI:1609413756
Name:VAQUERA, PEGGY A (LPCC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:VAQUERA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:CA
Mailing Address - Zip Code:96128-0115
Mailing Address - Country:US
Mailing Address - Phone:530-260-0344
Mailing Address - Fax:
Practice Address - Street 1:1306 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4432
Practice Address - Country:US
Practice Address - Phone:530-260-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC10336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health