Provider Demographics
NPI:1659658714
Name:CHARLEMAGNE-ADU, VANESSA LAURA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LAURA
Last Name:CHARLEMAGNE-ADU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 FESTIVAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3285
Mailing Address - Country:US
Mailing Address - Phone:646-262-7714
Mailing Address - Fax:
Practice Address - Street 1:8815 FESTIVAL WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3285
Practice Address - Country:US
Practice Address - Phone:646-262-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0847591104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker