Provider Demographics
NPI:1760834576
Name:VICK, SEAN (MA, LPA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:VICK
Suffix:
Gender:M
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STEVENS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1056
Mailing Address - Country:US
Mailing Address - Phone:919-731-3200
Mailing Address - Fax:
Practice Address - Street 1:201 STEVENS MILL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1056
Practice Address - Country:US
Practice Address - Phone:919-731-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist