Provider Demographics
NPI:1811022908
Name:WILMINGTON HEALTH ACCESS FOR TEENS
Entity Type:Organization
Organization Name:WILMINGTON HEALTH ACCESS FOR TEENS
Other - Org Name:NEW HANOVER WELLNESS CENTER-BH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DE BOVENKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:CMA (AAMA)
Authorized Official - Phone:910-790-9949
Mailing Address - Street 1:4005 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6816
Mailing Address - Country:US
Mailing Address - Phone:910-790-9949
Mailing Address - Fax:910-790-9455
Practice Address - Street 1:1307 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4331
Practice Address - Country:US
Practice Address - Phone:910-763-4988
Practice Address - Fax:910-790-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty