Provider Demographics
NPI:1912370917
Name:LOBO, VANESSA MIRANDA (MA,LPC, LPC-S)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MIRANDA
Last Name:LOBO
Suffix:
Gender:F
Credentials:MA,LPC, LPC-S
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LOBO
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC , LPC-S
Mailing Address - Street 1:1004 ABIGAIL CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8193
Mailing Address - Country:US
Mailing Address - Phone:843-468-6260
Mailing Address - Fax:
Practice Address - Street 1:1340 CELEBRATION BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5585
Practice Address - Country:US
Practice Address - Phone:843-536-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6990101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor