Individual
JOHNMARK VANNESS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4545 GEORGETOWN PL, STOCKTON, CA 95207-6215
(209) 955-1139
(209) 955-1143
Mailing address
3818 SCOTTSDALE RD, LODI, CA 95240-6805
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
13809
CA
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200806425
—
CA
Enumeration date
10/25/2021
Last updated
01/08/2024
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