Provider Demographics
NPI:1942412697
Name:BINGHAM, VIVIAN MARY (MA, LCADC, CSS)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:MARY
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MA, LCADC, CSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 KNOX ST STE 3&4
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1353
Mailing Address - Country:US
Mailing Address - Phone:606-545-9752
Mailing Address - Fax:606-545-0244
Practice Address - Street 1:417 KNOX ST STE 3&4
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1353
Practice Address - Country:US
Practice Address - Phone:606-545-9752
Practice Address - Fax:606-545-0244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health