Healthcare Provider Details

I. General information

NPI: 1194642819
Provider Name (Legal Business Name): NEXPHASE INTEGRATED HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SAINT SEBASTIAN WAY STE 5E
AUGUSTA GA
30901-2639
US

IV. Provider business mailing address

801 TRAVIS ST STE 2101
HOUSTON TX
77002-5730
US

V. Phone/Fax

Practice location:
  • Phone: 678-858-2378
  • Fax:
Mailing address:
  • Phone: 281-940-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANITA D VINCENT
Title or Position: CEO
Credential: CADC-II, LCDC, CCS,
Phone: 832-629-3099