Provider Demographics
NPI:1053299552
Name:VACANTI, SOPHIA GRACE (LGPC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:GRACE
Last Name:VACANTI
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 FOX LAKE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-6444
Mailing Address - Country:US
Mailing Address - Phone:402-320-4323
Mailing Address - Fax:
Practice Address - Street 1:9010 FOX LAKE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-6444
Practice Address - Country:US
Practice Address - Phone:402-320-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16926101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health