Provider Demographics
NPI:1013025873
Name:WAKE FOREST COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:WAKE FOREST COUNSELING SERVICES, INC.
Other - Org Name:WAKE FOREST COUNSELING SERVICES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-570-3004
Mailing Address - Street 1:PO BOX 98491
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-8491
Mailing Address - Country:US
Mailing Address - Phone:919-570-3004
Mailing Address - Fax:919-570-9225
Practice Address - Street 1:839C WAKE FOREST BUSINESS PARK STE E
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7181
Practice Address - Country:US
Practice Address - Phone:919-570-3004
Practice Address - Fax:919-570-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty