Provider Demographics
NPI:1639709702
Name:LEGINGTON, VANIA VERNIECE (LCSW)
Entity Type:Individual
Prefix:
First Name:VANIA
Middle Name:VERNIECE
Last Name:LEGINGTON
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 1:2901 BELT LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5931
Mailing Address - Country:US
Mailing Address - Phone:469-556-5908
Mailing Address - Fax:
Practice Address - Street 1:3816 S CLEAR CREEK RD STE C301
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4107
Practice Address - Country:US
Practice Address - Phone:254-773-4022
Practice Address - Fax:254-773-0919
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX52523OtherTEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS