Provider Demographics
NPI:1104976208
Name:FORD, VANESSA MARIE (LPCA)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:MARIE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0132
Mailing Address - Country:US
Mailing Address - Phone:800-321-8293
Mailing Address - Fax:
Practice Address - Street 1:1450 COLUMBUS AVE STE 105
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-3701
Practice Address - Country:US
Practice Address - Phone:800-321-8293
Practice Address - Fax:208-493-4900
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY340101YP2500X
IDLPC-3865101YP2500X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY3319Medicare ID - Type UnspecifiedMEDICARE