Provider Demographics
NPI:1194707364
Name:WARD, PENELOPE (PSYD)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 WRIGHTSVILLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4117
Mailing Address - Country:US
Mailing Address - Phone:910-200-2578
Mailing Address - Fax:
Practice Address - Street 1:3415 WRIGHTSVILLE AVENUE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4117
Practice Address - Country:US
Practice Address - Phone:910-200-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3073103TC0700X
NY014585103TC0700X
MD03883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000588Medicaid
NCE0787OtherMEDCOST
NC214440330OtherUBH
NC2160562OtherCIGNA
NC560652-000OtherMAGELLAN
NC046MYOtherBCBS
NC331904OtherTRICARE
NC2160562OtherCIGNA