Basic Information
Provider Information | |||||||||
NPI: | 1710947049 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VICKERS-ROBINSON | ||||||||
FirstName: | VALERIE | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VICKERS | ||||||||
OtherFirstName: | VALERIE | ||||||||
OtherMiddleName: | B | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LPC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1430 WILLOW LN | ||||||||
Address2: | WEST PARK C61-2 | ||||||||
City: | NORTH WILKESBORO | ||||||||
State: | NC | ||||||||
PostalCode: | 286593551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3366675151 | ||||||||
FaxNumber: | 8282625687 | ||||||||
Practice Location | |||||||||
Address1: | 1430 WILLOW LN | ||||||||
Address2: | WEST PARK C61-2 | ||||||||
City: | NORTH WILKESBORO | ||||||||
State: | NC | ||||||||
PostalCode: | 286593551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3366675151 | ||||||||
FaxNumber: | 8282625687 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/23/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4675 | NC | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
ID | Type | State | Issuer | Description | 2227096 | 01 | NC | CIGNA BEHAVIORAL HEALTH | OTHER | E0904 | 01 | NC | MEDCOST | OTHER | 13863 | 01 | NC | BCBS OF NC | OTHER |