Provider Demographics
NPI:1285063701
Name:POCOCK, WENDY (MACC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:POCOCK
Suffix:
Gender:F
Credentials:MACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GREENWICH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2314
Mailing Address - Country:US
Mailing Address - Phone:704-749-3536
Mailing Address - Fax:704-362-6776
Practice Address - Street 1:120 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2314
Practice Address - Country:US
Practice Address - Phone:704-749-3536
Practice Address - Fax:704-362-6776
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional