Theodora Renae Vance, LCSW
Individual provider Active NPI Clinical Social Worker · Afton, VA
NPI 1053063370 · NPPES record last updated Jan 19, 2022
Key facts
- NPI
- 1053063370
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0904009115 (VA)
- Practice address
- 51 Da Boyz PL
Afton, VA 22920-3063 - Phone
- (434) 466-8700
- NPI assigned
- Jan 19, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904009115 | VA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904009115 | VA | Yes |
Addresses
Primary practice location
51 Da Boyz PL
Afton, VA 22920-3063
Mailing address
51 Da Boyz PL
Afton, VA 22920-3063
Phone (434) 466-8700
Other providers in Afton, VA
- Gladys A. Perkins
- PT Plus of Afton, LLC
- William Ronald Pulliam
- Anne T Roane
- Stephen P Schmitz
- Wendy Vigdor-Hess
- Carl J Zovko
All providers in Afton, VA · Clinical Social Worker in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.