Provider Demographics
NPI:1942964382
Name:TALLEY, VANESSA M (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:M
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 WATKINS RD STE 227
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3350
Mailing Address - Country:US
Mailing Address - Phone:984-215-1262
Mailing Address - Fax:
Practice Address - Street 1:3307 WATKINS RD STE 227
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3350
Practice Address - Country:US
Practice Address - Phone:919-797-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010129101YM0800X
NCC014658101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1942964382Medicaid