Provider Demographics
NPI:1407016546
Name:DEACON, WENDOLYN (LPCS)
Entity Type:Individual
Prefix:MRS
First Name:WENDOLYN
Middle Name:
Last Name:DEACON
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7665
Mailing Address - Country:US
Mailing Address - Phone:919-935-2778
Mailing Address - Fax:
Practice Address - Street 1:304 N HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3939
Practice Address - Country:US
Practice Address - Phone:919-895-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC467375OtherMHN (TRICARE)
NC6104067Medicaid
NC1542VOtherBCBS
NC2667979OtherCIGNA
NC9367568OtherAETNA