Provider Demographics
NPI:1851478143
Name:VERGOLIAS, GEORGE LAMBROS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LAMBROS
Last Name:VERGOLIAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 SUMMERTON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8788
Mailing Address - Country:US
Mailing Address - Phone:919-523-8817
Mailing Address - Fax:
Practice Address - Street 1:10400 SUMMERTON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8788
Practice Address - Country:US
Practice Address - Phone:919-523-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000653Medicaid