Autumn Vinciquerra, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

5800 Glenwood Ave
Maple Heights, OH 44137-3700

Phone

(216) 438-6020

NPI assigned

Jun 20, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Signature Health, Inc.

  • Mental Health Counselor
  • Garfield Heights, OH
  • NPI 1679767289
  Medicare reassignment NPD
• Signature Health Inc

  • Long Term Care Pharmacy
  • Willoughby, OH
  • NPI 1740502335
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1841640984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 ROCKEFELLER RD",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440921939",
            "telephone_number": "440-231-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 GLENWOOD AVE",
            "city": "MAPLE HEIGHTS",
            "state": "OH",
            "postal_code": "441373700",
            "telephone_number": "216-438-6020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7232 Justin Way",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440604881",
            "country_code": "US",
            "telephone_number": "440-578-8200",
            "fax_number": "440-205-2417",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8445 Munson Rd",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440602410",
            "country_code": "US",
            "telephone_number": "440-255-1700",
            "fax_number": "440-205-2417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VINCIQUERRA",
        "first_name": "AUTUMN",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2844093",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kandyse Shanell Wagner
• Todd Emmit Wagner, M.D.
• Tyrone L Wagner
• Walgreen Co

• Mental Health Counselor in Maple Heights, OH
• Providers in Maple Heights, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.