NPIMap

Organization Active NPI

Wilmington Health Access for Teens

  • Mental Health Counselor
  • Wilmington, NC
National Provider Identifier
1063547990
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
WILMINGTON HEALTH ACCESS FOR TEENS
Practice address
1805 S 13TH St
Wilmington, NC 28401-6469
Phone
(910) 772-5552
Fax
(910) 772-5554
NPI assigned
Feb 22, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maria Van de Bovenkamp, CMA
Title
Medical Office Administrator
Phone
(910) 790-9949

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

1805 S 13TH St
Wilmington, NC 28401-6469

Mailing address

4005 Oleander Dr
Wilmington, NC 28403-6816
Phone (910) 790-9949

Other identifiers 1

IdentifierTypeStateIssuer
6005591MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
New Hanover Wellness Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4005 Oleander Dr
Wilmington, NC 28403
Phone (910) 332-3513

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063547990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036816",
            "telephone_number": "910-790-9949",
            "fax_number": "910-790-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 S 13TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016469",
            "telephone_number": "910-772-5552",
            "fax_number": "910-772-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON HEALTH ACCESS FOR TEENS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAN DE BOVENKAMP",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "MEDICAL OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-790-9949",
        "authorized_official_credential": "CMA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005591",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.