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General NPI Number Information
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NPI Number | 1316580830
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Entity Type | Individual
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Provider Name | ELIZABETH A VINCENT PHD, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 115 S SAINT MARYS ST STE D
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City | RALEIGH
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State | NC
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Zip | 27603-1785
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Country | US
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Telephone | 919-606-2699
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Fax |
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Provider Business Mailing Address
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Address Line | 510 N WILMINGTON ST APT 309
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City | RALEIGH
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State | NC
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Zip | 27604-8022
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Country | US
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Telephone | 919-606-2699
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10504
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License Number State | NC
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