MEDICARE: INTUITIVE MENTAL HEALTH SERVICE OF NORTH CAROLINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841931276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTUITIVE MENTAL HEALTH SERVICE OF NORTH CAROLINA

Provider Business Mailing Address
First Line	:	2625 PENFOLD LN
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5462
Country	:	US
Telephone Number	:	919-427-0926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1788 HERITAGE CENTER DR STE 202
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3972
Country	:	US
Telephone Number	:	919-530-9866
Fax Number	:	919-238-1642

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	ROBIN PETERSON
Credential	:	NP
Telephone Number	:	919-427-0926

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	03/23/2026

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