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General NPI Number Information
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NPI Number | 1174042907
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Entity Type | Individual
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Provider Name | MS. VICKIE M PERSAUD
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Gender | Female
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 605 THOMAS NELSON STREET,
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City | COLERAIN
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State | NC
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Zip | 27924-0134
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Country | US
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Telephone | 125-264-2534
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Fax | 252-642-5300
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Provider Business Mailing Address
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Address Line | PO BOX 134
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City | COLERAIN
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State | NC
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Zip | 27924-0134
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Country | US
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Telephone | 252-642-5345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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