Provider Demographics
NPI:1285952481
Name:KENT, VANESSA MOCK (MA)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MOCK
Last Name:KENT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:275 WATERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1989
Mailing Address - Country:US
Mailing Address - Phone:919-772-8459
Mailing Address - Fax:919-772-8459
Practice Address - Street 1:1215 JONES FRANKLIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3351
Practice Address - Country:US
Practice Address - Phone:919-851-1527
Practice Address - Fax:919-851-3555
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC#1872101YM0800X
NCLMFT#1129106H00000X
FLLMFT#1795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health