Individual
WANDA PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2577 W 5TH ST, GREENVILLE, NC 27834-7813
(252) 707-5205
(252) 707-5267
Mailing address
2577 W 5TH ST, GREENVILLE, NC 27834-7813
(252) 707-5205
(252) 707-5267
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
221639
NC
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
221639
NC
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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