Provider Demographics
NPI:1669753430
Name:DURRANT, VANESSA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:DURRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N JEFFERSON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3500
Mailing Address - Country:US
Mailing Address - Phone:301-712-9015
Mailing Address - Fax:
Practice Address - Street 1:10 N JEFFERSON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3500
Practice Address - Country:US
Practice Address - Phone:301-712-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1041C0700XMedicaid