Lady Advincula, ATR-BC, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

11808 Issued in CA

Practice address

11040 Bollinger Canyon Rd Ste E-439
San Ramon, CA 94582-4969

Phone

(925) 665-3668

NPI assigned

Apr 2, 2019

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)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sweet Mango Therapy Group, Licensed Clinical Social Worker, Inc.

  • Clinical Social Worker
  • San Ramon, CA
  • NPI 1295315323
  NPD

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1659833259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 BOLLINGER CANYON RD STE E-439",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945824969",
            "telephone_number": "925-665-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 BOLLINGER CANYON RD STE E-439",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945824969",
            "telephone_number": "925-665-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADVINCULA",
        "first_name": "LADY",
        "credential": "ATR-BC, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "11808",
            "primary": true
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "CA",
            "license": "17-136",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in San Ramon, CA
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; 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.