Healthcare Provider Details

I. General information

NPI: 1619895935
Provider Name (Legal Business Name): CHRISTINE STANCZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 CHIMNEY SWIFT DR
WAKE FOREST NC
27587-6755
US

IV. Provider business mailing address

5316 CHIMNEY SWIFT DR
WAKE FOREST NC
27587-6755
US

V. Phone/Fax

Practice location:
  • Phone: 919-228-8041
  • Fax:
Mailing address:
  • Phone: 919-228-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22935
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: