Provider Demographics
NPI:1356596720
Name:SOUTHERN WAKE COUNSELING CENTER
Entity type:Organization
Organization Name:SOUTHERN WAKE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDINE
Authorized Official - Middle Name:BERNICE
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-557-8222
Mailing Address - Street 1:1880 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3657
Mailing Address - Country:US
Mailing Address - Phone:919-557-8222
Mailing Address - Fax:919-557-8223
Practice Address - Street 1:1880 N BROAD ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3657
Practice Address - Country:US
Practice Address - Phone:919-557-8222
Practice Address - Fax:919-557-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103792Medicaid