Provider Demographics
NPI:1699488163
Name:MAGARINO-GOMEZ, VIVIAN (MA,LCMHCA, ATRP,NBCT)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:MAGARINO-GOMEZ
Suffix:
Gender:F
Credentials:MA,LCMHCA, ATRP,NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E CHATHAM ST STE H.
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1474
Mailing Address - Country:US
Mailing Address - Phone:919-889-6928
Mailing Address - Fax:
Practice Address - Street 1:101 E CHATHAM ST STE H
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1474
Practice Address - Country:US
Practice Address - Phone:919-889-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18373101YM0800X
NC21-128221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01126175OtherNATIONAL BOARD OF CERTIFIED TEACHER STANDARDS