Wakemed Specialists Group, LLC
Pediatrics, Developmental - Behavioral Pediatrics in Raleigh, NC. Organization (NPI-2).
NPI number1245895697
StatusActive
Last updated in NPPESJul 1, 2020
Details
- NPI
- 1245895697
- Entity type
- Organization (NPI-2)
- Legal business name
- Wakemed Specialists Group, LLC
- Organization subpart
- No
- Enumeration date
- May 1, 2019
- Certification date
- Jul 1, 2020
- Last updated
- Jul 1, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2080P0006X | Pediatrics, Developmental - Behavioral Pediatrics | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 103TB0200X | Psychologist, Cognitive & Behavioral | – | – |
Other names
- Wakemed Outpatient Behavioral Health (Doing Business As)
Practice location
23 Sunnybrook RdRaleigh, NC 27610-1855
Phone 919-350-7584 · Fax 919-231-0314
Mailing address
Po Box 603949Charlotte, NC 28260-3949
Phone 919-350-0552 · Fax 919-350-7687
Authorized official
Maria Jayoussi
Executive Director Of Finance
9193506089
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