Provider Demographics
NPI:1760013783
Name:STOVER, VANESA MARIE (LGSW)
Entity Type:Individual
Prefix:
First Name:VANESA
Middle Name:MARIE
Last Name:STOVER
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:ELEANOR
Mailing Address - State:WV
Mailing Address - Zip Code:25070-0051
Mailing Address - Country:US
Mailing Address - Phone:304-926-9471
Mailing Address - Fax:
Practice Address - Street 1:70 LIMEBERGER CREEK RD
Practice Address - Street 2:
Practice Address - City:POCA
Practice Address - State:WV
Practice Address - Zip Code:25159-7228
Practice Address - Country:US
Practice Address - Phone:304-926-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00945169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty