Provider Demographics
NPI:1700216058
Name:VINSON, LAMANICA (LPC)
Entity Type:Individual
Prefix:
First Name:LAMANICA
Middle Name:
Last Name:VINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 HIGHWAY 21
Mailing Address - Street 2:SUITE 101-297
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407
Mailing Address - Country:US
Mailing Address - Phone:912-346-1795
Mailing Address - Fax:
Practice Address - Street 1:272 S COLUMBIA AVE STE 109
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9026
Practice Address - Country:US
Practice Address - Phone:912-346-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional