Provider Demographics
NPI:1396281275
Name:FEOLA, VANESSA (PHD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:FEOLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 STUART ENGALS BLVD STE 204A
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3600
Mailing Address - Country:US
Mailing Address - Phone:843-849-9913
Mailing Address - Fax:843-881-6878
Practice Address - Street 1:1459 STUART ENGALS BLVD STE 204A
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3600
Practice Address - Country:US
Practice Address - Phone:843-849-9913
Practice Address - Fax:843-881-6878
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1834103T00000X
FLRBT-17-28295106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician