Provider Demographics
NPI:1700966611
Name:WISE, JANET M (MSW, CSAC, LCAS)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:M
Last Name:WISE
Suffix:
Gender:F
Credentials:MSW, CSAC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-1629
Mailing Address - Country:US
Mailing Address - Phone:919-989-1786
Mailing Address - Fax:919-989-1791
Practice Address - Street 1:1302 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3339
Practice Address - Country:US
Practice Address - Phone:919-989-1786
Practice Address - Fax:919-989-1791
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLICENSE# 1117101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLICENSE# 1117OtherCLINICAL ADDICTION SPEC.