Organization
WILMINGTON HEALTH ACCESS FOR TEENS, INC
Active
Parent organization
WILMINGTON HEALTH ACCESS FOR TEENS, INC
Other names
Lakeside Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILMINGTON HEALTH ACCESS FOR TEENS, INC
Authorized official
MARIA VAN DE BOVENKAMP CMA (AAMA) (DIRECTOR OF ADMINISTRATION)
(910) 790-9949
Entity
Organization
Contact information
Practice address
4005 OLEANDER DR, WILMINGTON, NC 28403-6816
(910) 772-5552
(910) 772-5554
Mailing address
1805 S 13TH ST, WILMINGTON, NC 28401-6469
(910) 772-5552
(910) 772-5554
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8701703
—
NC
Enumeration date
09/21/2006
Last updated
10/28/2010
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