Healthcare Provider Details

I. General information

NPI: 1801957576
Provider Name (Legal Business Name): COUNTY OF WAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SUNNYBROOK RD
RALEIGH NC
27610-1808
US

IV. Provider business mailing address

PO BOX 14169
RALEIGH NC
27620-4169
US

V. Phone/Fax

Practice location:
  • Phone: 919-212-7000
  • Fax: 919-250-3943
Mailing address:
  • Phone: 919-212-7817
  • Fax: 919-743-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA HENDERSON
Title or Position: PROVIDER CREDENTIALING COORDINATOR
Credential:
Phone: 919-212-7817