Provider Demographics
NPI:1275821241
Name:ANTHONY, VINSON O'NEAL SR (COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:VINSON
Middle Name:O'NEAL
Last Name:ANTHONY
Suffix:SR
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1519
Mailing Address - Country:US
Mailing Address - Phone:323-565-2043
Mailing Address - Fax:
Practice Address - Street 1:8455 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1519
Practice Address - Country:US
Practice Address - Phone:323-565-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1103011744101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)