Provider Demographics
NPI:1205854825
Name:VINCENT, GAIL ANN (PHD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PURDUE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5510
Mailing Address - Country:US
Mailing Address - Phone:910-693-7777
Mailing Address - Fax:910-693-1524
Practice Address - Street 1:160 PINEHURST AVE STE J
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7078
Practice Address - Country:US
Practice Address - Phone:910-693-7777
Practice Address - Fax:910-693-1524
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4102103TC0700X
NC3233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73729Medicare ID - Type UnspecifiedMEDICARE PROVIDER#