Healthcare Provider Details

I. General information

NPI: 1790164200
Provider Name (Legal Business Name): HILLARY VANN LPC,RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GATEWAY DR SUITE 105
CLAYTON NC
27520-2277
US

IV. Provider business mailing address

413 DIXIE DR
SELMA NC
27576-2377
US

V. Phone/Fax

Practice location:
  • Phone: 919-793-6445
  • Fax: 919-550-0337
Mailing address:
  • Phone: 919-604-1729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8986
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: