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NPI Code Detail

MEDICARE: DR. VINCENT COSTA DR.

MEDICARE: DR. VINCENT COSTA DR.
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
1101YP2500XProfessional Counselor8321NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18321OTHERNCLICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number : 1194113084
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VINCENT COSTA DR.
Provider Business Mailing Address
First Line : 9212 SEAMILL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28278-8004
Country : US
Telephone Number : 704-779-2961
Fax Number :
Provider Business Practice Location Address
First Line : 2124 CROWN CENTRE DR STE 400
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7804
Country : US
Telephone Number : 704-849-0144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2014
Last Update Date : 12/31/2014

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Directions to “ DR. VINCENT COSTA DR.” Practice Location

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