Basic Information
| Provider Information | |||||||||
| NPI: | 1528512886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINTO | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439522667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402837863 | ||||||||
| FaxNumber: | 7403460236 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 JOHNSON RD | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409967110 | ||||||||
| FaxNumber: | 7403460236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2016 | ||||||||
| LastUpdateDate: | 07/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C1100102 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | C1100102 | 01 | OH | STATE OF OHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND THERAPIST BOARD | OTHER |