Provider Demographics
NPI:1104979574
Name:VINCENT, PATRICIA (MSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:790 W LAKE LANSING RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8465
Mailing Address - Country:US
Mailing Address - Phone:517-332-2433
Mailing Address - Fax:517-332-4311
Practice Address - Street 1:790 W LAKE LANSING RD
Practice Address - Street 2:STE. 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8465
Practice Address - Country:US
Practice Address - Phone:517-332-2433
Practice Address - Fax:517-332-4311
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICAC101YA0400X
MI68010637391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical