Provider Demographics
NPI:1508247495
Name:VINSON, JASON (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:VINSON
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 NIGHTSTAR CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1268
Mailing Address - Country:US
Mailing Address - Phone:804-895-2427
Mailing Address - Fax:
Practice Address - Street 1:703 NIGHTSTAR CT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1268
Practice Address - Country:US
Practice Address - Phone:804-895-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 1303620104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker