Provider Demographics
NPI:1205168119
Name:VISION SERVICES GROUP
Entity type:Organization
Organization Name:VISION SERVICES GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-451-8476
Mailing Address - Street 1:4441 SIX FORKS RD # 106-122
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5729
Mailing Address - Country:US
Mailing Address - Phone:704-451-8476
Mailing Address - Fax:
Practice Address - Street 1:7101 PORTERS RD
Practice Address - Street 2:
Practice Address - City:ESMONT
Practice Address - State:VA
Practice Address - Zip Code:22937-1911
Practice Address - Country:US
Practice Address - Phone:704-451-8476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty