Active NPI
Charles Vanwagner, DST, LMFT
- Marriage & Family Therapist
- Raleigh, NC
National Provider Identifier
1316014525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 192
- Practice address
- 3733 National Dr
Suite 221
Raleigh, NC 27612-4065 - Phone
- (919) 783-5775
- Fax
- (919) 783-5775
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 192 | NC | Primary |
Addresses
Primary practice location
3733 National Dr
Suite 221
Raleigh, NC 27612-4065
Mailing address
3733 National Dr
Suite 221
Raleigh, NC 27612-4065
Phone (919) 783-5775
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84688 | Other | NC | BCBS PIN# |
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 |
|---|---|---|---|
| 192 | NC | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316014525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3733 NATIONAL DR",
"address_2": "SUITE 221",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276124065",
"telephone_number": "919-783-5775",
"fax_number": "919-783-5775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3733 NATIONAL DR",
"address_2": "SUITE 221",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276124065",
"telephone_number": "919-783-5775",
"fax_number": "919-783-5775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWAGNER",
"first_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "DST, LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "192",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN#",
"identifier": "84688",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.