Tricia Vick Gillian, MASTERS, SSP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4328 Issued in NC

Practice address

811 Bradberry LN
Indian Trail, NC 28079-5104

Phone

(252) 904-4426

NPI assigned

Sep 10, 2012

Last updated

Sep 10, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Tricia Lynn Vick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Illumii

  • Clinic/Center
  • Winston Salem, NC
  • NPI 1548885726
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347235200000",
    "number": "1962751677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 BRADBERRY LN",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795104",
            "telephone_number": "252-904-4426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 BRADBERRY LN",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795104",
            "telephone_number": "252-904-4426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAN",
        "first_name": "TRICIA",
        "middle_name": "VICK",
        "name_prefix": "Mrs.",
        "credential": "MASTERS, SSP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-10",
        "last_updated": "2012-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "4328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRICIA",
            "last_name": "VICK",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "credential": "MASTERS, SSP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychologist in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.