Provider Demographics
NPI:1700021557
Name:WAKE FOREST COUNSELING ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:WAKE FOREST COUNSELING ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:RAYSHELLA
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-554-4027
Mailing Address - Street 1:3021 BERKS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6599
Mailing Address - Country:US
Mailing Address - Phone:919-554-4027
Mailing Address - Fax:919-554-9375
Practice Address - Street 1:3021 BERKS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-554-4027
Practice Address - Fax:919-554-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty