Provider Demographics
NPI:1316580830
Name:VINCENT, ELIZABETH A (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N WILMINGTON ST APT 309
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8022
Mailing Address - Country:US
Mailing Address - Phone:919-606-2699
Mailing Address - Fax:
Practice Address - Street 1:115 S SAINT MARYS ST STE D
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1785
Practice Address - Country:US
Practice Address - Phone:919-606-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health