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General NPI Number Information
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NPI Number | 1215107701
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Entity Type | Organization
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Legal Business Name | VERGOLIAS PSYCHOLOGICAL CONSULTANTS PLLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 10400 SUMMERTON DR
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City | RALEIGH
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State | NC
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Zip | 27614-8788
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Country | US
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Telephone | 919-523-8817
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Fax | 919-803-8853
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Provider Business Mailing Address
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Address Line | 10400 SUMMERTON DR
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City | RALEIGH
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State | NC
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Zip | 27614-8788
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Country | US
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Telephone | 919-523-8817
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Fax | 919-803-8853
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. GEORGE LAMBROS VERGOLIAS
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Credential | PSY.D.
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Telephone | 919-523-8817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2721
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License Number State | NC
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