Provider Demographics
NPI:1588019145
Name:HERNANDEZ, VANESSA ELOISE (LISAC LAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ELOISE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LISAC LAC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ELOISE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISAC LAC
Mailing Address - Street 1:4108 S. ADELLE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212
Mailing Address - Country:US
Mailing Address - Phone:609-412-0853
Mailing Address - Fax:602-595-2511
Practice Address - Street 1:10000 N. 31ST AVE.
Practice Address - Street 2:APPLIED BEHAVIORAL INTERVENTIONS, PLLC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:609-412-0853
Practice Address - Fax:602-595-2511
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC15037101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)