Provider Demographics
NPI:1003296450
Name:DESIR, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DESIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 TERRELL MILL RD SE
Mailing Address - Street 2:BLDG. 1460 SUITE 205
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5496
Mailing Address - Country:US
Mailing Address - Phone:404-439-9981
Mailing Address - Fax:
Practice Address - Street 1:1355 TERRELL MILL RD SE
Practice Address - Street 2:BLDG. 1460 SUITE 205
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5496
Practice Address - Country:US
Practice Address - Phone:404-439-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC00826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional