Provider Demographics
NPI:1508028747
Name:MINOR, WENDY M
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:MINOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 OLD LIBERTY RD APT B
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-3434
Mailing Address - Country:US
Mailing Address - Phone:336-267-9709
Mailing Address - Fax:
Practice Address - Street 1:1232 OLD LIBERTY RD APT B
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-3434
Practice Address - Country:US
Practice Address - Phone:336-267-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251500000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health