Healthcare Provider Details

I. General information

NPI: 1124451182
Provider Name (Legal Business Name): WAKE FOREST HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 WESTCHESTER DR SUITE 402
HIGH POINT NC
27262-7299
US

IV. Provider business mailing address

1814 WESTCHESTER DR STE 402
HIGH POINT NC
27262-7369
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2205
  • Fax: 336-802-2208
Mailing address:
  • Phone: 336-802-2005
  • Fax: 336-702-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG MICHAEL GREVEN
Title or Position: SR VP CLINICAL OPERATIONS
Credential:
Phone: 336-716-1331