Provider Demographics
NPI:1265075493
Name:VANCE, MISTY DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:VANCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:DAWN
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0810
Mailing Address - Country:US
Mailing Address - Phone:276-964-6702
Mailing Address - Fax:276-964-0292
Practice Address - Street 1:113 CUMBERLAND ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-964-6702
Practice Address - Fax:276-964-0292
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040112491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical