Provider Demographics
NPI:1063009553
Name:VANOVER COUNSELING, INC.
Entity Type:Organization
Organization Name:VANOVER COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:VANOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:912-247-5000
Mailing Address - Street 1:107 MULRY DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2398
Mailing Address - Country:US
Mailing Address - Phone:912-247-5000
Mailing Address - Fax:850-842-2733
Practice Address - Street 1:107 MULRY DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2398
Practice Address - Country:US
Practice Address - Phone:912-247-5000
Practice Address - Fax:850-842-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904006487OtherSTATE LICENSURE BOARD
FLSW16556OtherSTATE LICENSURE