Provider Demographics
NPI:1184890147
Name:TRAPP-SPANN, VANESSA (CRC, LPC)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:TRAPP-SPANN
Suffix:
Gender:F
Credentials:CRC, LPC
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 480903
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5161
Mailing Address - Country:US
Mailing Address - Phone:704-877-3434
Mailing Address - Fax:704-875-6290
Practice Address - Street 1:1931 J N PEASE PLACE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4543
Practice Address - Country:US
Practice Address - Phone:704-877-3434
Practice Address - Fax:704-875-6290
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103907Medicaid