Provider Demographics
NPI:1669282943
Name:CLOUGH, VANESSA (LAPC, ATR)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:LAPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17103-2028
Mailing Address - Country:US
Mailing Address - Phone:717-379-7484
Mailing Address - Fax:
Practice Address - Street 1:1891 SANTA BARBARA DR STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4106
Practice Address - Country:US
Practice Address - Phone:717-553-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional