Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 2017043246 | MO |
N | 101YS0200X | School Counselor |
NPI | 1245690841 |
---|---|
Provider Name | Vesta Colvin |
First Address | Saint Louis, MO 63118-3506 |
Second Address | Saint Louis, MO 63130-4580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2016 |
Last Update Date | 10/04/2020 |