Provider Demographics
NPI:1265262554
Name:VICKERS, EVELYN BERNICE (LPC)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:BERNICE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-0036
Mailing Address - Country:US
Mailing Address - Phone:478-231-0177
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 36
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-0036
Practice Address - Country:US
Practice Address - Phone:478-231-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional