Provider Demographics
NPI:1760890339
Name:LAURSEN, WENDY (MA, LPC, LPCA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LAURSEN
Suffix:
Gender:F
Credentials:MA, LPC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PELICAN POINT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3567
Mailing Address - Country:US
Mailing Address - Phone:910-538-4397
Mailing Address - Fax:
Practice Address - Street 1:3806 PEACHTREE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6752
Practice Address - Country:US
Practice Address - Phone:910-251-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20965101YA0400X
NCA10857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)