Provider Demographics
NPI:1669346813
Name:MAIN, VANESSA DAWN
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DAWN
Last Name:MAIN
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 1:539 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-6122
Mailing Address - Country:US
Mailing Address - Phone:423-530-1685
Mailing Address - Fax:
Practice Address - Street 1:643 GREENWAY RD STE L
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4840
Practice Address - Country:US
Practice Address - Phone:828-263-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP020927104100000X
NCLCAS-29945101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)