Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003310442 |
---|---|
Provider Name | Vanessa Hope Warren |
First Address | Jackson, MS 39202-3442 |
Second Address | Pascagoula, MS 39567-3203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 24/03/2020 |