Shannon Nicole Verketis, RADT1 R1454820122

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1454820122 Issued in CA

Practice address

419 Pennsylvania St
Vallejo, CA 94590-6933

Phone

(707) 643-2715

Fax

(707) 643-8536

NPI assigned

Mar 10, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1646870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1962159889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 PENNSYLVANIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906933",
            "telephone_number": "707-643-2715",
            "fax_number": "707-643-8536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 PENNSYLVANIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906933",
            "telephone_number": "707-643-2715",
            "fax_number": "707-643-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERKETIS",
        "first_name": "SHANNON",
        "middle_name": "NICOLE",
        "credential": "RADT1 R1454820122",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-10",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1454820122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Veloria, D.O.
• Christian Daniel Venegas
• Rozzana Nava Verder-Aliga, LMFT
• Jose Luis Vergara
• Jocelynn N Verketis
• Yvonne D. Vermillion, LMFT
• Veterans Administration
• Kristy Vicari
• Danica Vicente
• Kimberly L Vick

• Addiction (Substance Use Disorder) Counselor in Vallejo, CA
• Providers in Vallejo, 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 Mar 10, 2022; 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.