Provider Demographics
NPI:1174042907
Name:PERSAUD, VICKIE M
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:M
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-0134
Mailing Address - Country:US
Mailing Address - Phone:252-642-5345
Mailing Address - Fax:
Practice Address - Street 1:605 THOMAS NELSON STREET,
Practice Address - Street 2:
Practice Address - City:COLERAIN
Practice Address - State:NC
Practice Address - Zip Code:27924-0134
Practice Address - Country:US
Practice Address - Phone:125-264-2534
Practice Address - Fax:252-642-5300
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2020-03-05
Deactivation Date:2019-05-19
Deactivation Code:
Reactivation Date:2020-02-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist