Provider Demographics
NPI:1740033307
Name:VINZANT, EACITA J
Entity type:Individual
Prefix:
First Name:EACITA
Middle Name:J
Last Name:VINZANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1332
Mailing Address - Country:US
Mailing Address - Phone:440-600-4329
Mailing Address - Fax:
Practice Address - Street 1:1099 GORDON RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1332
Practice Address - Country:US
Practice Address - Phone:440-600-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling