Provider Demographics
NPI:1710278189
Name:HARVEY-LENTS, VANESSA (DRAD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:HARVEY-LENTS
Suffix:
Gender:F
Credentials:DRAD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:HARVEY-LENTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DRAD
Mailing Address - Street 1:901 MADISON AVE
Mailing Address - Street 2:P.O. BOX 525 DAYTONA BEACH, FL 32115-0525
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1811
Mailing Address - Country:US
Mailing Address - Phone:386-334-4583
Mailing Address - Fax:
Practice Address - Street 1:901 MADISON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1811
Practice Address - Country:US
Practice Address - Phone:386-334-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL120786101YA0400X
FLADC-010572103TA0400X
FLIMT 529106H00000X
FL431405300000X
FLADC--010572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No405300000XOther Service ProvidersPrevention Professional