Provider Demographics
NPI:1124864723
Name:WAKE PSYCHOLOGICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:WAKE PSYCHOLOGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-590-9937
Mailing Address - Street 1:6009 FORDLAND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4476
Mailing Address - Country:US
Mailing Address - Phone:919-602-4262
Mailing Address - Fax:
Practice Address - Street 1:515 KEISLER DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7097
Practice Address - Country:US
Practice Address - Phone:919-590-9937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty