Provider Demographics
NPI:1376537886
Name:HALE, VANESSA L (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:L
Last Name:HALE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MARINA POINT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8415 BAYSHORE BLVD
Practice Address - Street 2:MACDILL AIR FORCE BASE 6MDOS/SGOH
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-1607
Practice Address - Country:US
Practice Address - Phone:813-827-9170
Practice Address - Fax:813-828-6868
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical