Provider Demographics
NPI:1508505801
Name:VANCE, NIKKI MAE
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:MAE
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 1:1021 QUARRIER ST STE 310
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2338
Mailing Address - Country:US
Mailing Address - Phone:303-513-3900
Mailing Address - Fax:
Practice Address - Street 1:1021 QUARRIER ST STE 310
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2338
Practice Address - Country:US
Practice Address - Phone:304-513-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor