Healthcare Provider Details

I. General information

NPI: 1265363790
Provider Name (Legal Business Name): CAMERON YESSENIA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 HERITAGE CENTER DR STE 201
WAKE FOREST NC
27587-4090
US

IV. Provider business mailing address

10117 SAN REMO PL
WAKE FOREST NC
27587-1622
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-1527
  • Fax:
Mailing address:
  • Phone: 919-438-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22907
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: