Healthcare Provider Details

I. General information

NPI: 1255484929
Provider Name (Legal Business Name): CARY BEHAVIORAL HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NE MAYNARD ROAD SUITE 200
CARY NC
27513
US

IV. Provider business mailing address

160 NE MAYNARD RD SUITE 200
CARY NC
27513-9670
US

V. Phone/Fax

Practice location:
  • Phone: 919-466-7540
  • Fax: 919-466-7543
Mailing address:
  • Phone: 919-466-7540
  • Fax: 919-466-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number200001056
License Number StateNC

VIII. Authorized Official

Name: WAHEED K BAJWA
Title or Position: PRESIDENT
Credential: MD
Phone: 919-466-7540