Healthcare Provider Details

I. General information

NPI: 1205365574
Provider Name (Legal Business Name): WESTERN WAKE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 N. SALEM STREET SUITE 105
APEX NC
27523
US

IV. Provider business mailing address

2172 N SALEM ST STE 105
APEX NC
27523-6457
US

V. Phone/Fax

Practice location:
  • Phone: 919-629-4360
  • Fax: 919-629-4362
Mailing address:
  • Phone: 919-629-4360
  • Fax: 919-629-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number092918
License Number StateNC

VIII. Authorized Official

Name: MR. TIMOTHY LAMONT GUNN
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 919-629-4360