Provider Demographics
NPI:1528512886
Name:MINTO, VIVIAN DAWN (LPC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:DAWN
Last Name:MINTO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7863
Mailing Address - Fax:740-346-0236
Practice Address - Street 1:3200 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952
Practice Address - Country:US
Practice Address - Phone:740-996-7110
Practice Address - Fax:740-346-0236
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1100102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC1100102OtherSTATE OF OHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND THERAPIST BOARD