Provider Demographics
NPI:1295851582
Name:VANNER, VALENCIA MENYAN (FAODP)
Entity type:Individual
Prefix:MS
First Name:VALENCIA
Middle Name:MENYAN
Last Name:VANNER
Suffix:
Gender:F
Credentials:FAODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 AMOS ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1802
Mailing Address - Country:US
Mailing Address - Phone:248-499-6132
Mailing Address - Fax:
Practice Address - Street 1:196 CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE B-201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1094
Practice Address - Country:US
Practice Address - Phone:248-253-0176
Practice Address - Fax:248-253-1570
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)