Provider Demographics
NPI:1477025344
Name:VICK, MAEGAN RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:RENEE
Last Name:VICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 19TH ST N APT 408
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3225
Mailing Address - Country:US
Mailing Address - Phone:205-936-9236
Mailing Address - Fax:
Practice Address - Street 1:402 OFFICE PARK DR STE 250
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2493
Practice Address - Country:US
Practice Address - Phone:205-936-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3577101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional