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General NPI Number Information
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NPI Number | 1639253818
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Entity Type | Individual
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Provider Name | DEVIN PAIGE VICKNAIR PHD LPC
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 1315 JESSE JEWELL PKWY NE STE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-219-9445
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 742616
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City | ATLANTA
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State | GA
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Zip | 30374-2616
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Country | US
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Telephone | 770-219-8420
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Fax | 770-219-8440
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 003253
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LPC003253
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC003253
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License Number State | GA
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