Provider Demographics
NPI:1871623256
Name:MARGOLIN, WANDA HELENE (PHD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:HELENE
Last Name:MARGOLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RONNI
Other - Middle Name:
Other - Last Name:MARGOLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3509 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4214
Mailing Address - Country:US
Mailing Address - Phone:919-782-8161
Mailing Address - Fax:
Practice Address - Street 1:3509 OLD POST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4214
Practice Address - Country:US
Practice Address - Phone:919-782-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2822260Medicare PIN