Healthcare Provider Details

I. General information

NPI: 1033454236
Provider Name (Legal Business Name): THE MARIPOSA SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 GREGSON DR
CARY NC
27511-6495
US

IV. Provider business mailing address

203 GREGSON DR
CARY NC
27511-6495
US

V. Phone/Fax

Practice location:
  • Phone: 919-461-0600
  • Fax: 919-461-0566
Mailing address:
  • Phone: 919-461-0600
  • Fax: 919-461-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRIS WENSIL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-461-0600