Healthcare Provider Details

I. General information

NPI: 1760487524
Provider Name (Legal Business Name): GAYE B VANCE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HIGHWAY 33 UNIT A
PELHAM AL
35124-4887
US

IV. Provider business mailing address

1940 HIGHWAY 33 UNIT A
PELHAM AL
35124-4887
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-4010
  • Fax: 205-664-9928
Mailing address:
  • Phone: 205-664-4010
  • Fax: 205-664-9928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number581
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: