Healthcare Provider Details

I. General information

NPI: 1639846264
Provider Name (Legal Business Name): VANESSA BUCHANAN LCSW, LISW, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA BURLINGAME

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 PRINCESS ANNE RD
VIRGINIA BEACH VA
23462-3222
US

IV. Provider business mailing address

5715 PRINCESS ANNE RD
VIRGINIA BEACH VA
23462-3222
US

V. Phone/Fax

Practice location:
  • Phone: 757-962-0748
  • Fax:
Mailing address:
  • Phone: 757-962-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2001393-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903003982
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2310146
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405733
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103957
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162672
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906012510
License Number StateVA
# 8
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017217
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: