Wilmington Health Access for Teens, Inc

Primary specialty

Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X

Legal business name

WILMINGTON HEALTH ACCESS FOR TEENS, INC

Doing business as

Lakeside Wellness Center

Practice address

4005 Oleander Dr
Wilmington, NC 28403-6816

Phone

(910) 772-5552

Fax

(910) 772-5554

NPI assigned

Sep 21, 2006

Last updated

Oct 28, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

WILMINGTON HEALTH ACCESS FOR TEENS, INCAs reported in NPPES

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

Authorized official

Name

Maria Van de Bovenkamp, CMA (AAMA)

Title

Director of Administration

Phone

(910) 790-9949

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeside Wellness Center Doing business as

Part of

Wilmington Health Access for Teens Inc

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1568561207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036816",
            "telephone_number": "910-772-5552",
            "fax_number": "910-772-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON HEALTH ACCESS FOR TEENS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILMINGTON HEALTH ACCESS FOR TEENS, INC",
        "enumeration_date": "2006-09-21",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "VAN DE BOVENKAMP",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATION",
        "authorized_official_telephone_number": "910-790-9949",
        "authorized_official_credential": "CMA (AAMA)"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8701703",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wilmington Health Access for Teens
• Wilmington Health Access for Teens
• Wilmington Health Access for Teens (New Hanover Wellness Center-BH)
• Wilmington Health Access for Teens, Inc (Laney High School Wellness Center)
• Wilmington Health Access for Teens, Inc (Ashley High School Wellness Center-BH)
• Wilmington Health Access for Teens, Inc
• Wilmington Health Access for Teens, Inc (Ashley Wellness Center)
• Wilmington Health Access for Teens, Inc (New Hanover High School Wellness Center)
• Wilmington Health PLLC
• Wilmington Health PLLC

• Adolescent Medicine (Family Medicine) Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Adolescent Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; 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.