Provider Demographics
NPI:1467720276
Name:COSTNER, VANIA ZANETA (LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:VANIA
Middle Name:ZANETA
Last Name:COSTNER
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:MRS
Other - First Name:VANIA
Other - Middle Name:ZANETA
Other - Last Name:COSTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:VANIA Z COSTNER
Mailing Address - Street 1:301 E WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2993
Mailing Address - Country:US
Mailing Address - Phone:336-333-6860
Mailing Address - Fax:336-275-1187
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2993
Practice Address - Country:US
Practice Address - Phone:336-333-6860
Practice Address - Fax:336-275-1187
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006903Medicaid