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General NPI Number Information
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NPI Number | 1750724324
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Entity Type | Individual
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Provider Name | WANDA S. OMODUNNI LCSW-A
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Gender | Female
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 202 N MAIN ST
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City | PEMBROKE
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State | NC
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Zip | 28372-5040
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Country | US
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Telephone | 910-491-9848
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2053
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City | GARNER
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State | NC
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Zip | 27529-2053
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Country | US
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Telephone | 910-498-9848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P006527
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NC
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