Provider Demographics
NPI:1083634307
Name:VIVIANI, ANNA MICHELE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MICHELE
Last Name:VIVIANI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1841
Mailing Address - Country:US
Mailing Address - Phone:309-282-1762
Mailing Address - Fax:309-674-8505
Practice Address - Street 1:8000 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1841
Practice Address - Country:US
Practice Address - Phone:309-282-1762
Practice Address - Fax:309-674-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health