Provider Demographics
NPI:1063057826
Name:ENGLISH, VANESSA DANIEL
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DANIEL
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 BRITTANY TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3469
Mailing Address - Country:US
Mailing Address - Phone:678-382-4096
Mailing Address - Fax:404-228-2721
Practice Address - Street 1:158 MORELAND AVE SE # 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1676
Practice Address - Country:US
Practice Address - Phone:678-382-4096
Practice Address - Fax:404-228-2721
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health