| Wake Psychiatry, Pllc | |
|
1500 Sunday Dr Ste 102 Raleigh NC 27607-5151 | |
| (919) 322-2413 | |
| (919) 322-2416 |
| Full Name | Wake Psychiatry, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1500 Sunday Dr Ste 102, Raleigh, North Carolina |
| Authorized Official Name and Position | Kellie M. Tolin (MANAGING PARTNER) |
| Authorized Official Contact | 9193222413 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Psychiatry, Pllc 1500 Sunday Dr Ste 102 Raleigh NC 27607-5151 Ph: (919) 322-2413 | Wake Psychiatry, Pllc 1500 Sunday Dr Ste 102 Raleigh NC 27607-5151 Ph: (919) 322-2413 |
| NPI Number | 1669763520 |
|---|---|
| Provider Enumeration Date | 04/27/2011 |
| Last Update Date | 08/10/2022 |
| Certification Date | 08/10/2022 |
| Medicare PECOS PAC ID | 3870764079 |
|---|---|
| Medicare Enrollment ID | O20110920000463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669763520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Kellie M Tolin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851373765 PECOS PAC ID: 4082767330 Enrollment ID: I20090804000164 |
| Provider Name | Carrie Pettit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053681908 PECOS PAC ID: 1759647480 Enrollment ID: I20171113000996 |
| Provider Name | Karen Reyes Lavieri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760900898 PECOS PAC ID: 8224393582 Enrollment ID: I20180607001898 |
| Provider Name | Jacquetta M Foushee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427319698 PECOS PAC ID: 5193953628 Enrollment ID: I20180924001330 |
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