Doctor Name: | LISA MARIE VANIER |
NPI Number: | 1548225162 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | AAS CADC |
License Number: | 23390 |
Business Practice Address: | 100 N Main Suite L100 East Peoria, IL - 61611 |
Business Phone Number: | 3096946462 |
Business Fax Number: | 3096947812 |
Mailing Address: | 100 N Main, Suite L100 EAST PEORIA |
State: | IL |
Postal Code: | 61611 |
Phone Number: | 3096946462 |
Fax Number: | 3096947812 |
NPI Enumeration Date: | 04/18/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 23390 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |