Provider Demographics
NPI:1265649636
Name:WARD, VINCENT PHELPS (PHD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:PHELPS
Last Name:WARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2519
Mailing Address - Country:US
Mailing Address - Phone:803-730-6489
Mailing Address - Fax:803-779-2007
Practice Address - Street 1:1415 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2519
Practice Address - Country:US
Practice Address - Phone:803-730-6489
Practice Address - Fax:803-779-2007
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1127101YM0800X
SC1129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist