Provider Demographics
NPI:1740269356
Name:NANCE, MIRANDA (LCSW)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:NANCE
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 1:336 HAGENSPRING RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3502
Mailing Address - Country:US
Mailing Address - Phone:757-609-3411
Mailing Address - Fax:
Practice Address - Street 1:1417 N BATTLEFIEDL BLVD
Practice Address - Street 2:COASTAL COUNSELING CENTER
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-436-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500788461041C0700X
MD156841041C0700X
VA09040050331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical