Provider Demographics
NPI:1104227586
Name:VANGILST, DORCAS HOPE (LPC)
Entity type:Individual
Prefix:MRS
First Name:DORCAS
Middle Name:HOPE
Last Name:VANGILST
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 21203
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71612-1203
Mailing Address - Country:US
Mailing Address - Phone:870-247-5222
Mailing Address - Fax:870-671-4847
Practice Address - Street 1:2304 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5005
Practice Address - Country:US
Practice Address - Phone:870-247-5222
Practice Address - Fax:870-671-4847
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1109079101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor