Healthcare Provider Details

I. General information

NPI: 1225962848
Provider Name (Legal Business Name): WRAP 2 FACILILTATOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CAROLINA SPRINGS BLVD
APEX NC
27539-8017
US

IV. Provider business mailing address

2949 NEW BERN AVE
RALEIGH NC
27610-1248
US

V. Phone/Fax

Practice location:
  • Phone: 919-985-1220
  • Fax:
Mailing address:
  • Phone: 919-985-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: LARRY LAMONT SMITH
Title or Position: OWNER
Credential: CPSS,WRAPFACILITATOR
Phone: 919-985-1220