Healthcare Provider Details

I. General information

NPI: 1508760729
Provider Name (Legal Business Name): FAYTH PIWONKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3806 PARK AVE UNIT 1
WILMINGTON NC
28403-6738
US

IV. Provider business mailing address

2656 ALVERNIA DR
CASTLE HAYNE NC
28429-1409
US

V. Phone/Fax

Practice location:
  • Phone: 910-210-6160
  • Fax:
Mailing address:
  • Phone: 910-210-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22974
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: