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General NPI Number Information
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NPI Number | 1033602974
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Entity Type | Organization
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Legal Business Name | VIVID COUNSELING, LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 6101 DELMAR BLVD STE A
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City | SAINT LOUIS
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State | MO
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Zip | 63112-1203
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Country | US
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Telephone | 314-730-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 DELMAR BLVD STE A
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City | SAINT LOUIS
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State | MO
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Zip | 63112-1203
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Country | US
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Telephone | 314-730-0111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YVETTE HAMILTON-HAWKINS
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Credential | LPC
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Telephone | 314-730-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2012037388
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License Number State | MO
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