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General NPI Number Information
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NPI Number | 1992254114
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Entity Type | Organization
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Legal Business Name | UNCG NICHOLAS A VACC COUNSELING AND CONSULTING CLINIC
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 524 HIGHLAND AVENUE
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City | GREENSBORO
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State | NC
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Zip | 27412-5018
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Country | US
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Telephone | 336-334-5112
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Fax | 336-256-0121
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Provider Business Mailing Address
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Address Line | 524 HIGHLAND AVENUE
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City | GREENSBORO
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State | NC
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Zip | 27412-5018
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Country | US
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Telephone | 336-334-5112
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Fax | 336-256-0121
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Authorized Official
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Title or Position | CLINICAL PROFESSOR/CLINIC DIRECTOR
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Name | DR. A. KEITH MOBLEY
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Credential | PHD, LPCS, ACS, NCC
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Telephone | 336-334-5215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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