Provider Demographics
NPI:1831146158
Name:VAILLANCOURT, ROBERT ARTHUR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ARTHUR
Last Name:VAILLANCOURT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2888
Mailing Address - Country:US
Mailing Address - Phone:919-942-8596
Mailing Address - Fax:919-929-0120
Practice Address - Street 1:1611 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2888
Practice Address - Country:US
Practice Address - Phone:919-942-8596
Practice Address - Fax:919-929-0120
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0001781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical