Healthcare Provider Details

I. General information

NPI: 1306453832
Provider Name (Legal Business Name): HSIAO-WEN WANG PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 FALLS OF NEUSE RD STE 200
RALEIGH NC
27615-3549
US

IV. Provider business mailing address

5456 S MIAMI BLVD APT 303
DURHAM NC
27703-8267
US

V. Phone/Fax

Practice location:
  • Phone: 919-418-1718
  • Fax: 919-794-5715
Mailing address:
  • Phone: 919-886-7128
  • Fax: 919-794-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5776
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: