Provider Demographics
NPI:1922617315
Name:DENNISON, VIVIAN LEE (MS, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:LEE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MS, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5673
Mailing Address - Country:US
Mailing Address - Phone:254-791-5815
Mailing Address - Fax:
Practice Address - Street 1:3300 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5673
Practice Address - Country:US
Practice Address - Phone:254-791-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13961101YA0400X
TX83983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)