Provider Demographics
NPI:1922147362
Name:VINCENT, HORTENSIA MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HORTENSIA
Middle Name:MARIA
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 1:726 RAMPART ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-6344
Mailing Address - Country:US
Mailing Address - Phone:337-477-3011
Mailing Address - Fax:
Practice Address - Street 1:726 RAMPART ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-6344
Practice Address - Country:US
Practice Address - Phone:337-477-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health