Provider Demographics
NPI:1619693173
Name:LUNA, VANESSA M (LCSWA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:LUNA
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N TRADE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-9433
Mailing Address - Country:US
Mailing Address - Phone:980-202-2288
Mailing Address - Fax:
Practice Address - Street 1:616 NORTH BROOME ST
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:980-202-2288
Practice Address - Fax:980-280-1543
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0170661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty