Individual
NANCY VANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4310 BOULDERCREST RD, ELLENWOOD, GA 30294-2423
(678) 437-5909
Mailing address
4310 BOULDERCREST RD, ELLENWOOD, GA 30294-2423
(678) 437-5909
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
08/04/2015
Last updated
08/04/2015
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