Healthcare Provider Details

I. General information

NPI: 1366256448
Provider Name (Legal Business Name): MIA VINCENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 T ST NE
WASHINGTON DC
20002-1519
US

IV. Provider business mailing address

180 GREENMEADOW WAY APT A
LARGO MD
20774-1148
US

V. Phone/Fax

Practice location:
  • Phone: 202-281-3950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: