Provider Demographics
NPI:1700472016
Name:VANESSA LANE COUNSELING LLC
Entity Type:Organization
Organization Name:VANESSA LANE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:802-291-0356
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0624
Mailing Address - Country:US
Mailing Address - Phone:802-291-0356
Mailing Address - Fax:805-885-1600
Practice Address - Street 1:160 WALL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3528
Practice Address - Country:US
Practice Address - Phone:802-291-0356
Practice Address - Fax:802-885-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1033859Medicaid