Provider Demographics
NPI:1649369174
Name:W E B DUBOIS CDC
Entity type:Organization
Organization Name:W E B DUBOIS CDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-915-0122
Mailing Address - Street 1:POST OFFICE BOX 1828
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-1828
Mailing Address - Country:US
Mailing Address - Phone:919-556-0709
Mailing Address - Fax:919-556-5160
Practice Address - Street 1:150A NORTH WHITE STREET
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2600
Practice Address - Country:US
Practice Address - Phone:919-556-0709
Practice Address - Fax:919-556-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-08-13
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health