Active NPI
Wanda K Ceres, LPC
- Professional Counselor
- Durham, NC
National Provider Identifier
1245429448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6760
- Practice address
- 725 Broad St
Durham, NC 27705-4833 - Phone
- (919) 433-1491
- Fax
- (919) 433-1498
- NPI assigned
- Oct 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6760 | NC | Primary |
Addresses
Primary practice location
725 Broad St
Durham, NC 27705-4833
Mailing address
3210 Fairhill Dr
Raleigh, NC 27612-3215
Phone (919) 256-0824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6103721 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6760 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195084800000",
"number": "1245429448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3210 FAIRHILL DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276123215",
"telephone_number": "919-256-0824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 BROAD ST",
"city": "DURHAM",
"state": "NC",
"postal_code": "277054833",
"telephone_number": "919-433-1491",
"fax_number": "919-433-1498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERES",
"first_name": "WANDA",
"middle_name": "K",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-24",
"last_updated": "2007-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "6760",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6103721",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.