Individual
MS. LISA GAYLE VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC1, LBSW
Contact information
Practice address
1400 CLEVELAND ST, GREENVILLE, SC 29607-2410
(864) 467-3790
Mailing address
1400 CLEVELAND ST, GREENVILLE, SC 29607-2410
(864) 467-3790
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1068
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1108266
SC
Other
Enumeration date
04/12/2012
Last updated
04/12/2012
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