Provider Demographics
NPI:1225153331
Name:IVEY, WENDY HUDSON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:HUDSON
Last Name:IVEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 KIRBY SMITH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-6923
Mailing Address - Country:US
Mailing Address - Phone:910-228-2189
Mailing Address - Fax:910-350-2036
Practice Address - Street 1:3525 KIRBY SMITH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-6923
Practice Address - Country:US
Practice Address - Phone:910-228-2189
Practice Address - Fax:910-350-2036
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5315101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool