Active NPI
Wanda S. Omodunni, LCSW-A
- Clinical Social Worker
- Pembroke, NC
National Provider Identifier
1750724324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 202 N Main St
Pembroke, NC 28372-5040 - Phone
- (910) 491-9848
- NPI assigned
- Apr 12, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Clinical Social Worker | 1041C0700X | |||
| Clinical Social Worker | 1041C0700X | P006527 | NC | |
| Clinical Social Worker | 1041C0700X | NC | Primary |
Addresses
Primary practice location
202 N Main St
Pembroke, NC 28372-5040
Mailing address
PO Box 2053
Garner, NC 27529-2053
Phone (910) 498-9848
Other names 1
- Mrs. Wanda Renfrow
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | karenm@takeflightservices.com |
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 |
|---|---|---|---|
| P006527 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624406400000",
"number": "1750724324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2053",
"city": "GARNER",
"state": "NC",
"postal_code": "275292053",
"telephone_number": "910-498-9848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 N MAIN ST",
"city": "PEMBROKE",
"state": "NC",
"postal_code": "283725040",
"telephone_number": "910-491-9848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMODUNNI",
"first_name": "WANDA",
"middle_name": "S.",
"name_prefix": "Mrs.",
"credential": "LCSW-A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-12",
"last_updated": "2021-06-23",
"certification_date": "2021-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P006527",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "karenm@takeflightservices.com",
"affiliation": "N",
"address_1": "202 N Main St",
"city": "Pembroke",
"state": "NC",
"country_code": "US",
"postal_code": "283725040",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "WANDA",
"last_name": "RENFROW",
"prefix": "MRS.",
"credential": "MSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Pembroke, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.