Organization
SOUTHPARK PSYCHOLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL VINCENT LCPC (OWNER)
(309) 797-2900
Entity
Organization
Contact information
Practice address
2100 52ND AVE, MOLINE, IL 61265-6366
(309) 797-2900
(309) 797-2147
Mailing address
2100 52ND AVE, MOLINE, IL 61265-6366
(309) 797-2900
(309) 797-2147
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/30/2006
Last updated
01/26/2018
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