MEDICARE: HILLARY VANN LPC,RPT

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
1	101YP2500X	Professional Counselor	8986	NC

General Provider Information

NPI Number	:	1790164200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILLARY VANN LPC,RPT

Provider Business Mailing Address
First Line	:	413 DIXIE DR
Second Line	:
City	:	SELMA
State	:	NC
Zip	:	27576-2377
Country	:	US
Telephone Number	:	919-604-1729
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 GATEWAY DR
Second Line	:	SUITE 105
City	:	CLAYTON
State	:	NC
Zip	:	27520-2277
Country	:	US
Telephone Number	:	919-793-6445
Fax Number	:	919-550-0337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	05/29/2015

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