Vanessa Stallworth

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1440340721 Issued in CA

Practice address

1963 N E St
San Bernardino, CA 92405-3919

Phone

(909) 881-6146

NPI assigned

Sep 22, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693785600000",
    "number": "1235800087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1963 N E ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053919",
            "telephone_number": "909-881-6146",
            "fax_number": "909-881-3479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1963 N E ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053919",
            "telephone_number": "909-881-6146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "VANESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-22",
        "last_updated": "2023-09-04",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1440340721",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "APCC14195",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Johns Community Health
• Charity Lenae Stagg
• Susan Marie Staley, SLP
• Raevyn Stallworth
• Sondra Stallworth
• Christina Louise Stamper
• Kyiesha Annette Stampley, LVN
• Barbara Ann Stanfield, D.C.
• Breanna Stanley
• Christopher Briggs Stanley

• Addiction (Substance Use Disorder) Counselor in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.