Provider Demographics
NPI:1871839308
Name:PAYNE, VANESSA (MS, LGPC)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MS, LGPC
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 980
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0980
Mailing Address - Country:US
Mailing Address - Phone:410-535-5400
Mailing Address - Fax:410-414-9413
Practice Address - Street 1:3819 HARBOR RD
Practice Address - Street 2:103
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3109
Practice Address - Country:US
Practice Address - Phone:410-286-0547
Practice Address - Fax:410-286-8950
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6930101YM0800X
101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)