Provider Demographics
NPI:1588083521
Name:SWAIN, VINCENT I
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:SWAIN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 STONY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6609
Mailing Address - Country:US
Mailing Address - Phone:734-485-8725
Mailing Address - Fax:734-485-6103
Practice Address - Street 1:320 MILLER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3385
Practice Address - Country:US
Practice Address - Phone:734-821-0216
Practice Address - Fax:734-821-0218
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)