Provider Demographics
NPI:1669487385
Name:VINCENT, ANTONIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:
Last Name:VINCENT
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 1:439 US HIGHWAY 158 W
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-8304
Mailing Address - Country:US
Mailing Address - Phone:336-694-9331
Mailing Address - Fax:336-694-7511
Practice Address - Street 1:439 US HIGHWAY 158 W
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-8304
Practice Address - Country:US
Practice Address - Phone:336-694-9331
Practice Address - Fax:336-694-7511
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0020671041C0700X
NCC0077471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical