Provider Demographics
NPI:1558174425
Name:NEUSTROM, VANESSSA LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:VANESSSA
Middle Name:LEIGH
Last Name:NEUSTROM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1104
Mailing Address - Country:US
Mailing Address - Phone:919-418-3002
Mailing Address - Fax:
Practice Address - Street 1:1181 WEAVER DAIRY RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1869
Practice Address - Country:US
Practice Address - Phone:984-974-3966
Practice Address - Fax:984-974-3966
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical