Provider Demographics
NPI:1154930980
Name:VINSON, KEVIN DALE (CSC-AD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DALE
Last Name:VINSON
Suffix:
Gender:M
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 KELSO DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3113
Mailing Address - Country:US
Mailing Address - Phone:410-486-2500
Mailing Address - Fax:410-780-8686
Practice Address - Street 1:8909 KELSO DR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3113
Practice Address - Country:US
Practice Address - Phone:410-486-2500
Practice Address - Fax:410-780-8686
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MDSC2373101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)