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NPI Code Detail

MEDICARE: MS. TERRY VANCE PH.D.

MEDICARE: MS. TERRY VANCE PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist#315NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104879OTHERNCBCBS OF NC

General Provider Information

NPI Number : 1528154051
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TERRY VANCE PH.D.
Provider Business Mailing Address
First Line : 1611 E. FRANKLIN STREET
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27514
Country : US
Telephone Number : 919-942-8596
Fax Number : 919-929-0120
Provider Business Practice Location Address
First Line : 1611 E. FRANKLIN STREET
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27514
Country : US
Telephone Number : 919-942-8596
Fax Number : 919-929-0120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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