Provider Demographics
NPI:1831703644
Name:VINCENT, LISA M (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
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 1:455 E EISENHOWER PKWY
Mailing Address - Street 2:SUITE 300 PMB 1004
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3324
Mailing Address - Country:US
Mailing Address - Phone:912-675-4797
Mailing Address - Fax:248-782-3430
Practice Address - Street 1:455 E EISENHOWER PKWY
Practice Address - Street 2:SUITE 300 PMB 1004
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3324
Practice Address - Country:US
Practice Address - Phone:912-675-4797
Practice Address - Fax:248-782-3430
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health