Provider Demographics
NPI:1578769600
Name:VINCENT, JAMES ROBERT (LPCC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:VINCENT
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 CERRILLOS RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3508
Mailing Address - Country:US
Mailing Address - Phone:505-455-9981
Mailing Address - Fax:
Practice Address - Street 1:1339 CERRILLOS RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3508
Practice Address - Country:US
Practice Address - Phone:505-455-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0084161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional