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General NPI Number Information
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NPI Number | 1124864723
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Entity Type | Organization
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Legal Business Name | WAKE PSYCHOLOGICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 07/02/2024
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 515 KEISLER DR STE 101
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City | CARY
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State | NC
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Zip | 27518-7097
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Country | US
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Telephone | 919-590-9937
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Fax |
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Provider Business Mailing Address
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Address Line | 6009 FORDLAND DR
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City | RALEIGH
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State | NC
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Zip | 27606-4476
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Country | US
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Telephone | 919-602-4262
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WHITNEY EDWARDS
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Credential |
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Telephone | 919-590-9937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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