Provider Demographics
NPI:1699319202
Name:VANN, AUDRA ALEXANDER (LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:ALEXANDER
Last Name:VANN
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:MS
Other - First Name:AUDRA
Other - Middle Name:DEANN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2530 MERIDIAN PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5273
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:
Practice Address - Street 1:2530 MERIDIAN PKWY STE 115
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5273
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health