Organization
HEALTHCORE
Active
Organization
HEALTHCORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ANGELA DEVON WILSON (PROGRAM MANAGER)
(919) 872-1178
Entity
Organization
Contact information
Practice address
1100 NAVAHO DR, SUITE 128, RALEIGH, NC 27609-7319
(919) 872-1178
(919) 872-1170
Mailing address
1100 NAVAHO DR, SUITE 128, RALEIGH, NC 27609-7319
(919) 872-1178
(919) 872-1170
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TH0100X
Health Service Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Enumeration date
09/27/2007
Last updated
10/27/2007
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