Active NPI
Charles Wade
- Counselor
- Wake Forest, NC
National Provider Identifier
1407538754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 12543A
- Practice address
- 1740 Heritage Center Dr Ste 202
Wake Forest, NC 27587-9849 - Phone
- (919) 285-4802
- NPI assigned
- Aug 7, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 12543A | NC | Primary |
Addresses
Primary practice location
1740 Heritage Center Dr Ste 202
Wake Forest, NC 27587-9849
Mailing address
1740 Heritage Center Dr Ste 202
Wake Forest, NC 27587-9849
Phone (919) 285-4802
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 |
|---|---|---|---|
| 12543A | NC | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691366400000",
"number": "1407538754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1740 HERITAGE CENTER DR STE 202",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275879849",
"telephone_number": "919-285-4802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1740 HERITAGE CENTER DR STE 202",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275879849",
"telephone_number": "919-285-4802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "CHARLES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-07",
"last_updated": "2023-08-07",
"certification_date": "2023-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "12543A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.