Provider Demographics
NPI:1902210784
Name:WATSON, WENDI (LCAS, CADC)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCAS, CADC
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:M
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597
Mailing Address - Country:US
Mailing Address - Phone:919-986-4130
Mailing Address - Fax:919-872-1441
Practice Address - Street 1:3826 BLAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6239
Practice Address - Country:US
Practice Address - Phone:919-872-1441
Practice Address - Fax:919-872-1455
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0117331041C0700X
NC23849101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902210784Medicaid