Individual
ANGELINE BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RADT-1
Contact information
Practice address
993 POSTAL WAY, VISTA, CA 92083-6945
(760) 630-9922
Mailing address
993 POSTAL WAY, VISTA, CA 92083-6945
(760) 630-9922
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12826
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
117454
CA
101YP2500X
Professional Counselor
Primary
22473
CA
106H00000X
Marriage & Family Therapist
117454
CA
Other
Enumeration date
11/07/2019
Last updated
04/18/2026
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