Provider Demographics
NPI:1457731192
Name:SPAVENTA-VANCIL, KATHRYN ZOE (MA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ZOE
Last Name:SPAVENTA-VANCIL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LONGHILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2717
Mailing Address - Country:US
Mailing Address - Phone:805-708-3365
Mailing Address - Fax:
Practice Address - Street 1:262 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23186-0002
Practice Address - Country:US
Practice Address - Phone:757-221-3620
Practice Address - Fax:757-221-3615
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor