Provider Demographics
NPI:1952529752
Name:WIMBISH-VANDERBECK, LAURA WIMBISH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:WIMBISH
Last Name:WIMBISH-VANDERBECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WIMBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8180 OLD GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-6770
Mailing Address - Country:US
Mailing Address - Phone:919-545-2161
Mailing Address - Fax:
Practice Address - Street 1:199 W SALISBURY ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4149
Practice Address - Country:US
Practice Address - Phone:919-545-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical