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NPI Code Detail

MEDICARE: MINNIE SIMMONS VICKERS MSW, LCSWA

MEDICARE: MINNIE SIMMONS VICKERS MSW, LCSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerP019317NC

General Provider Information

NPI Number : 1023897980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MINNIE SIMMONS VICKERS MSW, LCSWA
Provider Business Mailing Address
First Line : 1125 RESERVOIR VIEW LN
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3025
Country : US
Telephone Number : 919-523-1156
Fax Number :
Provider Business Practice Location Address
First Line : 2000 S MAIN ST
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-9335
Country : US
Telephone Number : 919-521-0665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2023
Last Update Date : 09/28/2023

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