Provider Demographics
NPI:1053560730
Name:LADRIE, VANESSA DANIELL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:DANIELL
Last Name:LADRIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 LAGERFELD WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1643
Mailing Address - Country:US
Mailing Address - Phone:919-452-5202
Mailing Address - Fax:
Practice Address - Street 1:8400 SIX FORKS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3068
Practice Address - Country:US
Practice Address - Phone:919-452-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0061561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007044Medicaid