Provider Demographics
NPI:1831832252
Name:VANFLEET, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:VANFLEET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ISABELLA ST APT 2-3C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1288
Mailing Address - Country:US
Mailing Address - Phone:859-279-5211
Mailing Address - Fax:
Practice Address - Street 1:1749 WALTON NICHOLSON PIKE
Practice Address - Street 2:NEWPORT KY 41071
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051
Practice Address - Country:US
Practice Address - Phone:859-279-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)