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General NPI Number Information
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NPI Number | 1770483422
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Entity Type | Individual
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Provider Name | FREDERICK JUNIOR WINLEY LCMHCA
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Gender | Male
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 400 W RANSOM ST
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-2434
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Country | US
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Telephone | 610-799-7030
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Fax | 919-285-3233
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Provider Business Mailing Address
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Address Line | PO BOX 153
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City | PANTEGO
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State | NC
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Zip | 27860-0153
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Country | US
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Telephone | 989-915-9646
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A23728
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License Number State | NC
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