Provider Demographics
NPI:1689223257
Name:VANBUREN OWENS, AAISHA SHEONNA
Entity Type:Individual
Prefix:
First Name:AAISHA
Middle Name:SHEONNA
Last Name:VANBUREN OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 SUNSET AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3751
Mailing Address - Country:US
Mailing Address - Phone:252-985-3216
Mailing Address - Fax:
Practice Address - Street 1:2747 SUNSET AVE STE 109
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3751
Practice Address - Country:US
Practice Address - Phone:252-985-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCLCAS-A-29314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC435201Medicaid