Wake Renewal Counseling, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C006619 Issued in NC

Legal business name

WAKE RENEWAL COUNSELING, PLLC

Practice address

1008 Big Oak CT Ste F
Knightdale, NC 27545-6566

Phone

(919) 520-9392

Fax

(919) 261-1675

NPI assigned

Jul 1, 2013

Last updated

Jul 1, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Keisha Hinton Bryan, LCSW, LCASNPI 1073799227

Title

Ownter/Therapist

Phone

(919) 520-9392

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keisha Hinton Bryan, LCSW, LCAS

  • Clinical Social Worker
  • Knightdale, NC
  • NPI 1073799227
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1205276599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 BIG OAK CT STE F",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456566",
            "telephone_number": "919-520-9392",
            "fax_number": "919-261-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 BIG OAK CT STE F",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456566",
            "telephone_number": "919-520-9392",
            "fax_number": "919-261-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE RENEWAL COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-01",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_middle_name": "HINTON",
        "authorized_official_title_or_position": "OWNTER/THERAPIST",
        "authorized_official_telephone_number": "919-520-9392",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW, LCAS"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C006619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6112015",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vital Health Services, LLC
• Bethany Waddey
• Wake Counseling Associates, PLLC
• Wake Forest Pediatric Associates, PLLC (WFPA, PLLC - Knightdale Pediatric Office)
• Wake Heart and Vascular Associates PA
• Wake Specialty Physicians LLC (WakeMed Primary Care Knightdale)
• Wake Spine and Disc Inc
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1816)
• Walgreen Co (Walgreens #09555)
• Elizabeth Wallace, PT

• Clinical Social Worker in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.