Provider Demographics
NPI:1992254114
Name:UNCG NICHOLAS A VACC COUNSELING AND CONSULTING CLINIC
Entity type:Organization
Organization Name:UNCG NICHOLAS A VACC COUNSELING AND CONSULTING CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROFESSOR/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:A.
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCS, ACS, NCC
Authorized Official - Phone:336-334-5215
Mailing Address - Street 1:524 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27412-5018
Mailing Address - Country:US
Mailing Address - Phone:336-334-5112
Mailing Address - Fax:336-256-0121
Practice Address - Street 1:524 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27412-5018
Practice Address - Country:US
Practice Address - Phone:336-334-5112
Practice Address - Fax:336-256-0121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty