Healthcare Provider Details

I. General information

NPI: 1962169110
Provider Name (Legal Business Name): CARMELIA RYIEL WARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date: 08/05/2022
Reactivation Date: 09/15/2022

III. Provider practice location address

PO BOX 460
WAKE FOREST NC
27588-0460
US

IV. Provider business mailing address

PO BOX 460
WAKE FOREST NC
27588-0460
US

V. Phone/Fax

Practice location:
  • Phone: 984-399-0043
  • Fax:
Mailing address:
  • Phone: 984-399-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018072
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-200489
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: