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General NPI Number Information
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NPI Number | 1447592209
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Entity Type | Organization
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Legal Business Name | VINSON PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 4236 SHERLIE WEAVIL RD
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City | WINSTON SALEM
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State | NC
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Zip | 27107
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Country | US
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Telephone | 336-972-1164
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Fax |
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Provider Business Mailing Address
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Address Line | 4236 SHERLIE WEAVIL RD
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City | WINSTON-SALEM
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State | NC
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Zip | 27107
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Country | US
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Telephone | 336-972-1164
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | MARTHA ANNE VINSON
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Credential | PHD
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Telephone | 336-972-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 1596
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License Number State | NC
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