Provider Demographics
NPI:1508195553
Name:VANCE, PHOEBE A
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:A
Last Name:VANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 LEE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8001
Mailing Address - Country:US
Mailing Address - Phone:423-499-8877
Mailing Address - Fax:423-499-9356
Practice Address - Street 1:7333 LEE HWY STE C
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8001
Practice Address - Country:US
Practice Address - Phone:423-499-8877
Practice Address - Fax:423-499-9356
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health