Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 78424 | TX |
N | 101YS0200X | School Counselor | 1507399 | TX |
NPI | 1154931616 |
---|---|
Provider Name | David Andrew Vick |
First Address | Watauga, TX 76148-1359 |
Second Address | Southlake, TX 76092-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2020 |
Last Update Date | 08/08/2020 |