Provider Demographics
NPI:1073069068
Name:WISE, ATIA (LCMHC)
Entity type:Individual
Prefix:DR
First Name:ATIA
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PURPLE ASTER ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-4403
Mailing Address - Country:US
Mailing Address - Phone:919-824-7394
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1027
Practice Address - Country:US
Practice Address - Phone:617-379-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional