Provider Demographics
NPI:1114450210
Name:DELMINDO-MOORE, VANESSA MARIAH (LICDCGAMBCS)
Entity Type:Individual
Prefix:
First Name:VANESSA MARIAH
Middle Name:
Last Name:DELMINDO-MOORE
Suffix:
Gender:F
Credentials:LICDCGAMBCS
Other - Prefix:
Other - First Name:VANESSA MARIAH
Other - Middle Name:
Other - Last Name:DELMINDO-MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICDCGAMBCS
Mailing Address - Street 1:272 ESSEX PL
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7561
Mailing Address - Country:US
Mailing Address - Phone:740-644-4999
Mailing Address - Fax:740-919-4349
Practice Address - Street 1:5460 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4074
Practice Address - Country:US
Practice Address - Phone:614-568-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161755101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)