Provider Demographics
NPI:1356366967
Name:STATON, VANESSA MARIA HAWKINS (MA LPA)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MARIA HAWKINS
Last Name:STATON
Suffix:
Gender:F
Credentials:MA LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4195
Mailing Address - Country:US
Mailing Address - Phone:704-364-1106
Mailing Address - Fax:866-210-4848
Practice Address - Street 1:6809 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4195
Practice Address - Country:US
Practice Address - Phone:704-364-1106
Practice Address - Fax:866-210-4848
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1079103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4364854OtherNC
NC135WWOtherBCBS