Provider Demographics
NPI:1891425088
Name:VINCENT, ANITA D (LCDC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:D
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62811
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77205-2801
Mailing Address - Country:US
Mailing Address - Phone:832-557-0146
Mailing Address - Fax:
Practice Address - Street 1:8010 SUFFIELD GLEN LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2022
Practice Address - Country:US
Practice Address - Phone:832-557-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)