Healthcare Provider Details

I. General information

NPI: 1831601541
Provider Name (Legal Business Name): VANESSA CROWE-PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 LEXINGTON AVE
SPRINGFIELD OH
45505
US

IV. Provider business mailing address

2624 LEXINGTON AVE
SPRINGFIELD OH
45505-2620
US

V. Phone/Fax

Practice location:
  • Phone: 937-328-5300
  • Fax: 937-322-4900
Mailing address:
  • Phone: 937-328-5300
  • Fax: 937-322-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.2506955
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: