Provider Demographics
NPI:1093308876
Name:DUNHAM, VANESSA (LCSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 ROUND ROCK AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4003
Mailing Address - Country:US
Mailing Address - Phone:512-687-0347
Mailing Address - Fax:
Practice Address - Street 1:2410 ROUND ROCK AVE STE 250
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4003
Practice Address - Country:US
Practice Address - Phone:512-687-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX512791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51279OtherSOCIAL WORK LICENSE NUMBER FROM TEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL