Provider Demographics
NPI:1467767921
Name:SHORT, VANESSA CRAIG (MA, CAS, LPA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:CRAIG
Last Name:SHORT
Suffix:
Gender:F
Credentials:MA, CAS, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 GLEN HOLLOW LN NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8728
Mailing Address - Country:US
Mailing Address - Phone:828-256-2586
Mailing Address - Fax:828-256-2586
Practice Address - Street 1:3945 GLEN HOLLOW LN NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-8728
Practice Address - Country:US
Practice Address - Phone:828-256-2586
Practice Address - Fax:828-256-2586
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0758103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool