Healthcare Provider Details

I. General information

NPI: 1598006066
Provider Name (Legal Business Name): VANESSA PLACERES LPC, RPT, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JACKSON ST NE
ATLANTA GA
30312-1303
US

IV. Provider business mailing address

180 JACKSON ST NE
ATLANTA GA
30312-1303
US

V. Phone/Fax

Practice location:
  • Phone: 209-609-7958
  • Fax:
Mailing address:
  • Phone: 706-688-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1608746
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number009126
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: