| Wake Renewal Counseling, Pllc | |
|
1008 Big Oak Ct Ste F Knightdale NC 27545-6566 | |
| (919) 520-9392 | |
| (919) 261-1675 |
| Full Name | Wake Renewal Counseling, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1008 Big Oak Ct Ste F, Knightdale, North Carolina |
| Authorized Official Name and Position | Keisha Hinton Bryan (OWNTER/THERAPIST) |
| Authorized Official Contact | 9195209392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Renewal Counseling, Pllc 1008 Big Oak Ct Ste F Knightdale NC 27545-6566 Ph: (919) 520-9392 | Wake Renewal Counseling, Pllc 1008 Big Oak Ct Ste F Knightdale NC 27545-6566 Ph: (919) 520-9392 |
| NPI Number | 1205276599 |
|---|---|
| Provider Enumeration Date | 07/01/2013 |
| Last Update Date | 07/01/2013 |
| Medicare PECOS PAC ID | 9638310790 |
|---|---|
| Medicare Enrollment ID | O20130801000302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205276599 | NPI | - | NPPES |
| 6112015 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C006619 (North Carolina) | Primary |
| Provider Name | Keisha H Bryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073799227 PECOS PAC ID: 0941339253 Enrollment ID: I20100525000806 |
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