Individual
DR. ELEANOR VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD, LPC, CSAC
Contact information
Practice address
10560 MAIN ST, SUITE 405, FAIRFAX, VA 22030-7182
(703) 474-6427
Mailing address
11350 RANDOM HILLS RD, 8TH FLOOR, FAIRFAX, VA 22030-6044
(703) 934-6006
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710102639
VA
101YP2500X
Professional Counselor
Primary
0701006683
VA
Other
Enumeration date
11/09/2016
Last updated
01/22/2017
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