Provider Demographics
NPI:1336381250
Name:VINCE, DANA M (LPC, MHSP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:M
Last Name:VINCE
Suffix:
Gender:F
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CENTER PARK DR.
Mailing Address - Street 2:SUITE 228
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-283-1777
Mailing Address - Fax:
Practice Address - Street 1:123 CENTER PARK DR.
Practice Address - Street 2:SUITE 228
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922
Practice Address - Country:US
Practice Address - Phone:865-283-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2625101YM0800X
FLMH 8863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH8863OtherFLORIDA STATE LICENSING BOARD