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General NPI Number Information
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NPI Number | 1841676533
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Entity Type | Organization
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Legal Business Name | UNC WAKEBROOK
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 107 SUNNYBROOK RD
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City | RALEIGH
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State | NC
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Zip | 27610-1827
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Country | US
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Telephone | 984-974-4863
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Fax | 984-974-4911
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Provider Business Mailing Address
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Address Line | 107 SUNNYBROOK RD
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City | RALEIGH
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State | NC
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Zip | 27610-1827
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Country | US
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Telephone | 984-974-4863
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Fax | 984-974-4911
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Authorized Official
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Title or Position | CLINICAL INSTRUCTOR
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Name | NEIDA RODRIGUES
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Credential | MSW, LCAS-A
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Telephone | 984-974-4863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State | NC
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