Provider Demographics
NPI:1649027251
Name:KNIGHT, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WHIPPOORWILL WAY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-8206
Mailing Address - Country:US
Mailing Address - Phone:201-397-0504
Mailing Address - Fax:
Practice Address - Street 1:2001 WHIPPOORWILL WAY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-8206
Practice Address - Country:US
Practice Address - Phone:201-397-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician