Provider Demographics
NPI:1508957192
Name:VAILLANCOURT, VERONIQUE S (LCSW)
Entity Type:Individual
Prefix:
First Name:VERONIQUE
Middle Name:S
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 WOODSTEAD CT
Mailing Address - Street 2:STE 420
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3413
Mailing Address - Country:US
Mailing Address - Phone:281-363-4220
Mailing Address - Fax:281-364-9404
Practice Address - Street 1:1610 WOODSTEAD CT
Practice Address - Street 2:STE 420
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3413
Practice Address - Country:US
Practice Address - Phone:281-363-4220
Practice Address - Fax:281-364-9404
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
48145516OtherWAUSAU
9266102OtherPHCS
474020OtherVALUE OPTIONS
227338OtherCOMPSYCH