Provider Demographics
NPI:1003650409
Name:FARLEY, VANESSA LYNN (PARAPROFESSIONAL)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:LYNN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PARAPROFESSIONAL
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:POLLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1745 PHOENIX BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5534
Mailing Address - Country:US
Mailing Address - Phone:470-619-0770
Mailing Address - Fax:
Practice Address - Street 1:1745 PHOENIX BLVD STE 305
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5534
Practice Address - Country:US
Practice Address - Phone:470-619-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator