Provider Demographics
NPI:1831358647
Name:VANCE, AUDRA MICHELLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:MICHELLE
Last Name:VANCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:AUDRA
Other - Middle Name:MICHELLE
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1812 ROSEWELL DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8474
Mailing Address - Country:US
Mailing Address - Phone:803-984-7974
Mailing Address - Fax:
Practice Address - Street 1:1812 ROSEWELL DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8474
Practice Address - Country:US
Practice Address - Phone:803-984-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health