Provider Demographics
NPI:1801044888
Name:VINCENT, ANDREA NICOLE (LMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 SE ELLIS CT
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-8765
Mailing Address - Country:US
Mailing Address - Phone:360-982-0660
Mailing Address - Fax:
Practice Address - Street 1:1616 SE ELLIS CT
Practice Address - Street 2:SUITE 290
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-8765
Practice Address - Country:US
Practice Address - Phone:360-982-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60419287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health