Provider Demographics
NPI:1891835328
Name:HARRIS, WENDY B (MED LICENSED PROFESS)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:B
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MED LICENSED PROFESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 EASTWOOD ROAD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-256-1800
Mailing Address - Fax:910-256-4473
Practice Address - Street 1:1908 EASTWOOD ROAD
Practice Address - Street 2:SUITE 223
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-256-1800
Practice Address - Fax:910-256-4473
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health