Provider Demographics
NPI:1841937299
Name:VICK, CHRISTINE PETRA (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PETRA
Last Name:VICK
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WALSH LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5756
Mailing Address - Country:US
Mailing Address - Phone:512-762-5208
Mailing Address - Fax:
Practice Address - Street 1:4118 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1335
Practice Address - Country:US
Practice Address - Phone:512-651-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX79468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional