Provider Demographics
NPI:1184829889
Name:VANN, DEBBIE BC (MHC-LP)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:BC
Last Name:VANN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4043
Mailing Address - Country:US
Mailing Address - Phone:845-220-6639
Mailing Address - Fax:845-562-0768
Practice Address - Street 1:45 POPLAR ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4043
Practice Address - Country:US
Practice Address - Phone:845-220-6639
Practice Address - Fax:845-562-0768
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered