Healthcare Provider Details

I. General information

NPI: 1689107039
Provider Name (Legal Business Name): WENDY KRULL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 FAIR MEADOWS LN
RALEIGH NC
27607-6465
US

IV. Provider business mailing address

2587 RAVENHILL DR
FAYETTEVILLE NC
28303-5451
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-1543
  • Fax: 910-483-2026
Mailing address:
  • Phone: 910-323-1543
  • Fax: 910-483-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007934
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: