MEDICARE: COUNTY OF WAKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251B00000X	Case Management Agency	NC
2	251S00000X	Community/Behavioral Health Agency	NC
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295761617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF WAKE

Provider Business Mailing Address
First Line	:	PO BOX 14169
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27620-4169
Country	:	US
Telephone Number	:	919-250-3184
Fax Number	:	919-250-3943

Provider Business Practice Location Address
First Line	:	3000 FALSTAFF RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1813
Country	:	US
Telephone Number	:	919-250-3100
Fax Number	:	919-250-3194

Authorized Official
Title or Position	:	CLIENT ACCOUNTING MANAGER
Name	:	ALICE O WILKERSON
Credential	:
Telephone Number	:	919-212-7817

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	06/18/2010

Similar Medicare Providers

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1649949496 — CIPRIANNA HAYNES
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1821105669 — MRS. ELLEN BETTS CLEMMER LCSW
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1750473864 — CHRISTINE WASSMUTH LCSW
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Directions to “COUNTY OF WAKE ” Practice Location

Language	Start Address	Practice Location

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