Provider Demographics
NPI:1760889612
Name:VINCENTI, MICHELE EMILY (LISAC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:EMILY
Last Name:VINCENTI
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:EMILY
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2914
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-265-6973
Practice Address - Street 1:1802 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8134
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-258-6140
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-1506101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)