Provider Demographics
NPI:1093141269
Name:LANZAS, VIVETTE (MS, LMHC, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:VIVETTE
Middle Name:
Last Name:LANZAS
Suffix:
Gender:F
Credentials:MS, LMHC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 DOLLEY MADISON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4282
Mailing Address - Country:US
Mailing Address - Phone:336-632-3505
Mailing Address - Fax:
Practice Address - Street 1:603 DOLLEY MADISON RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4282
Practice Address - Country:US
Practice Address - Phone:336-632-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15853101YM0800X
FLMH 9234101YM0800X
NC10920101YP2500X
FL103K00000X
NC16583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1295050292OtherNPI FOR BUSINESS ELITE PSYCHOTHERAPY, LLC