Provider Demographics
NPI:1053715151
Name:MEAD, VICKI L (LPC/MHSP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:MEAD
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3309
Mailing Address - Country:US
Mailing Address - Phone:615-594-2514
Mailing Address - Fax:
Practice Address - Street 1:2000 WARFIELD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3424
Practice Address - Country:US
Practice Address - Phone:615-594-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional