Provider Demographics
NPI:1033598099
Name:BOATRIGHT, VANESSA (MSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BOATRIGHT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 BAGGETTE RD
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-7643
Mailing Address - Country:US
Mailing Address - Phone:843-615-3812
Mailing Address - Fax:803-472-1027
Practice Address - Street 1:1931 BAGGETTE RD
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-7643
Practice Address - Country:US
Practice Address - Phone:843-615-3812
Practice Address - Fax:803-472-1027
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008697101Y00000X, 102L00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst