Provider Demographics
NPI:1578808143
Name:VANN, LORA (LCSWA, LCAS-A)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:VANN
Suffix:
Gender:F
Credentials:LCSWA, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:OCRACOKE
Mailing Address - State:NC
Mailing Address - Zip Code:27960-0473
Mailing Address - Country:US
Mailing Address - Phone:252-532-5371
Mailing Address - Fax:
Practice Address - Street 1:305 BACK ROAD
Practice Address - Street 2:
Practice Address - City:OCRACOKE
Practice Address - State:NC
Practice Address - Zip Code:27960
Practice Address - Country:US
Practice Address - Phone:252-532-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0070271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical