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General NPI Number Information
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NPI Number | 1851705156
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Entity Type | Organization
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Legal Business Name | MICHELE VINCENT, LCSW, LLC
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 115 HANSEL ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-5039
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Country | US
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Telephone | 337-257-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 204 OAK HILL LN
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-6170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE R VINCENT
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Credential | LCSW
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Telephone | 337-257-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4274
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License Number State | LA
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