MEDICARE: MR. GERALD B VINSON LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	I0002192	OH
2	101YP2500X	Professional Counselor	I0002192	OH
3	101YM0800X	Mental Health Counselor	I0002192	OH

General Provider Information

NPI Number	:	1801089172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD B VINSON LISW

Provider Business Mailing Address
First Line	:	1735 S HAWKINS AVE STE A
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-3902
Country	:	US
Telephone Number	:	330-867-5400
Fax Number	:	330-454-4357

Provider Business Practice Location Address
First Line	:	1735 S HAWKINS AVE STE A
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320
Country	:	US
Telephone Number	:	330-867-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	07/02/2019

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