Provider Demographics
NPI:1396443214
Name:VINCENT, ANTOINETTE R (LPC)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:R
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CARDIFF LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-0114
Mailing Address - Country:US
Mailing Address - Phone:972-979-3841
Mailing Address - Fax:
Practice Address - Street 1:300 N INTERSTATE HIGHWAY 35 E # 3
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5226
Practice Address - Country:US
Practice Address - Phone:972-979-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty