Provider Demographics
NPI:1932864451
Name:VINTON, LAURA JANE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:VINTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JANE
Other - Last Name:MOUANOUTOUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:993 N VULCAN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1794
Mailing Address - Country:US
Mailing Address - Phone:616-325-8710
Mailing Address - Fax:
Practice Address - Street 1:328 ENCINITAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-8704
Practice Address - Country:US
Practice Address - Phone:858-330-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1235211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical