Provider Demographics
NPI:1972735702
Name:VACA, PATRICK ROBERT (MA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ROBERT
Last Name:VACA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 5TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3095
Mailing Address - Country:US
Mailing Address - Phone:704-421-2064
Mailing Address - Fax:
Practice Address - Street 1:604 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5902
Practice Address - Country:US
Practice Address - Phone:704-226-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional