Provider Demographics
NPI:1063637411
Name:NC DHHS CHILD AND FAMILY WELL-BEING
Entity Type:Organization
Organization Name:NC DHHS CHILD AND FAMILY WELL-BEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:QIUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-707-5527
Mailing Address - Street 1:DPH- EARLY INTERVENTION BR
Mailing Address - Street 2:1916 MAIL SERVICE CENTER
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-1916
Mailing Address - Country:US
Mailing Address - Phone:919-707-5520
Mailing Address - Fax:919-870-4834
Practice Address - Street 1:3311 BURNT MILL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2654
Practice Address - Country:US
Practice Address - Phone:910-945-6021
Practice Address - Fax:910-945-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403402Medicaid