Organization
FUQUAY FAMILY COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY WAGNER LMFT (OWNER)
(919) 412-7321
Entity
Organization
Contact information
Practice address
602 E ACADEMY ST, SUITE 205, FUQUAY VARINA, NC 27526-2382
(919) 346-5357
Mailing address
602 E ACADEMY ST, SUITE 205, FUQUAY VARINA, NC 27526-2382
(919) 346-5357
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
820
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135K8
BCBS
NC
01
—
2150812
CIGNA BEHAVIORAL HEALTH
NC
01
—
229376546
UNITED BEHAVIORAL HEALTH
NC
Enumeration date
09/18/2008
Last updated
09/18/2008
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