Provider Demographics
NPI:1447951868
Name:WIMBERLY, VANIA (LCSWA)
Entity type:Individual
Prefix:
First Name:VANIA
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 PALLADIUM RIDGE LN APT 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-7426
Mailing Address - Country:US
Mailing Address - Phone:864-764-5643
Mailing Address - Fax:
Practice Address - Street 1:801 EAST MOREHEAD STREET
Practice Address - Street 2:SUITE 105 #3138
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:803-792-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO18663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker