Provider Demographics
NPI:1447447412
Name:ABERNATHY, VANESSA RENEE (PSYD, HSP-P)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:RENEE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:PSYD, HSP-P
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:ABERNATHY
Other - Last Name:ENOCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, HSP-P
Mailing Address - Street 1:2618 BATTLEGROUND AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1924
Mailing Address - Country:US
Mailing Address - Phone:336-663-3140
Mailing Address - Fax:
Practice Address - Street 1:2618 BATTLEGROUND AVE STE 304
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1924
Practice Address - Country:US
Practice Address - Phone:336-663-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical