Provider Demographics
NPI:1932299773
Name:VANCONANT, VICKI L (LMSW)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:L
Last Name:VANCONANT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 E BATTLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBUSH
Mailing Address - State:MI
Mailing Address - Zip Code:48878-9782
Mailing Address - Country:US
Mailing Address - Phone:989-433-0202
Mailing Address - Fax:
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010725881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical