Provider Demographics
NPI:1215107701
Name:VERGOLIAS PSYCHOLOGICAL CONSULTANTS PLLC
Entity type:Organization
Organization Name:VERGOLIAS PSYCHOLOGICAL CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LAMBROS
Authorized Official - Last Name:VERGOLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:919-523-8817
Mailing Address - Street 1:10400 SUMMERTON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8788
Mailing Address - Country:US
Mailing Address - Phone:919-523-8817
Mailing Address - Fax:919-803-8853
Practice Address - Street 1:10400 SUMMERTON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8788
Practice Address - Country:US
Practice Address - Phone:919-523-8817
Practice Address - Fax:919-803-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000653Medicaid