Provider Demographics
NPI:1467697805
Name:TOLAND, VIVIAN ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ELAINE
Last Name:TOLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5208
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-7702
Mailing Address - Country:US
Mailing Address - Phone:409-698-2382
Mailing Address - Fax:
Practice Address - Street 1:174 HICKORY
Practice Address - Street 2:
Practice Address - City:BROOKELAND
Practice Address - State:TX
Practice Address - Zip Code:75931
Practice Address - Country:US
Practice Address - Phone:409-698-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical