Provider Demographics
NPI:1336357581
Name:WESLEY, ANNE MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARGARET
Last Name:WESLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 CROCUS CT
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8630
Mailing Address - Country:US
Mailing Address - Phone:919-606-3623
Mailing Address - Fax:919-363-4668
Practice Address - Street 1:547 KEISLER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-9309
Practice Address - Country:US
Practice Address - Phone:919-606-3623
Practice Address - Fax:919-363-4668
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO3095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002316Medicaid
NC11694OtherBCBS PROVIDER ID NUMBER