Healthcare Provider Details

I. General information

NPI: 1336003771
Provider Name (Legal Business Name): WENDY HANDY CLERGY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAHA BLACKFEATHER CLERGY

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N TRADE ST
WINSTON SALEM NC
27101-2981
US

IV. Provider business mailing address

2810 CARRIAGE DR APT K
WINSTON SALEM NC
27106-5328
US

V. Phone/Fax

Practice location:
  • Phone: 336-462-6356
  • Fax:
Mailing address:
  • Phone: 336-571-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: