Provider Demographics
NPI:1427081579
Name:MAGINN, VINCENT JOHN (PHD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOHN
Last Name:MAGINN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EUROPA DRIVE
Mailing Address - Street 2:SUITE 341
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2389
Mailing Address - Country:US
Mailing Address - Phone:919-929-0456
Mailing Address - Fax:919-929-3070
Practice Address - Street 1:100 EUROPA DRIVE
Practice Address - Street 2:SUITE 341
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2389
Practice Address - Country:US
Practice Address - Phone:919-929-0456
Practice Address - Fax:919-929-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000030Medicaid
NC6000030Medicaid