Provider Demographics
NPI:1053667725
Name:VANNOY, MICHAEL JAMES (MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:VANNOY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 POPLAR GROVE RD S
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9885
Mailing Address - Country:US
Mailing Address - Phone:828-773-3402
Mailing Address - Fax:866-967-1976
Practice Address - Street 1:789 POPLAR GROVE RD S
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-9885
Practice Address - Country:US
Practice Address - Phone:828-773-3402
Practice Address - Fax:866-567-1976
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2086101YA0400X
NCA9546101YP2500X, 101YM0800X
NC291214101YP2500X
NC3037101YA0400X
NC9546101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor