| Dwane Wynne Lpc Pa | |
|
356 Grovers Knob Blowing Rock NC 28605-9012 | |
| (919) 618-7120 | |
| Not Available |
| Full Name | Dwane Wynne Lpc Pa |
|---|---|
| Speciality | Counselor |
| Location | 356 Grovers Knob, Blowing Rock, North Carolina |
| Authorized Official Name and Position | Donald Dwane Wynne (PRESIDENT) |
| Authorized Official Contact | 9196187120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dwane Wynne Lpc Pa 356 Grovers Knob Blowing Rock NC 28605-9012 Ph: (919) 618-7120 | Dwane Wynne Lpc Pa 356 Grovers Knob Blowing Rock NC 28605-9012 Ph: (919) 618-7120 |
| NPI Number | 1659110567 |
|---|---|
| Provider Enumeration Date | 05/21/2024 |
| Last Update Date | 05/21/2024 |
| Certification Date | 05/21/2024 |
| Medicare PECOS PAC ID | 7315489309 |
|---|---|
| Medicare Enrollment ID | O20240605002906 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659110567 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Donald Dwane Wynne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043267412 PECOS PAC ID: 8224570213 Enrollment ID: I20240605003697 |
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