Provider Demographics
NPI:1740474774
Name:HARRIS, WENDY G (MED, LPC, NCC, NBCT)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:G
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MED, LPC, NCC, NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 CEDAR AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4419
Mailing Address - Country:US
Mailing Address - Phone:910-799-1933
Mailing Address - Fax:910-799-1966
Practice Address - Street 1:4608 CEDAR AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4419
Practice Address - Country:US
Practice Address - Phone:910-799-1933
Practice Address - Fax:910-799-1966
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCBLPC # 4127101YP2500X
NCNCDPI LIC. #G K-12101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103686Medicaid