Provider Demographics
NPI:1720280480
Name:VINIARD, GREGORY SCOTT (LCPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:VINIARD
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SPRING MILL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6566
Mailing Address - Country:US
Mailing Address - Phone:217-546-3100
Mailing Address - Fax:217-546-3284
Practice Address - Street 1:3001 SPRING MILL DR
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6566
Practice Address - Country:US
Practice Address - Phone:217-546-3100
Practice Address - Fax:217-546-3284
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional