Healthcare Provider Details

I. General information

NPI: 1124619051
Provider Name (Legal Business Name): ANNA WHALEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA DUPONT

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 WESTON PKWY
CARY NC
27513-2201
US

IV. Provider business mailing address

2104 BEACHWOOD DR
SANFORD NC
27330-9272
US

V. Phone/Fax

Practice location:
  • Phone: 919-677-1400
  • Fax:
Mailing address:
  • Phone: 980-621-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13410
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1211702
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: