Provider Demographics
NPI:1447343454
Name:WAKE COUNTY PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:WAKE COUNTY PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBREEN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:919-562-1080
Mailing Address - Street 1:1906 S MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5033
Mailing Address - Country:US
Mailing Address - Phone:919-562-1080
Mailing Address - Fax:919-570-3243
Practice Address - Street 1:1906 S MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5033
Practice Address - Country:US
Practice Address - Phone:919-562-1080
Practice Address - Fax:919-570-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005282Medicaid
NC6005282Medicaid