| Doctor Name: | MISS QWENZELLA WYNN |
| NPI Number: | 1215375563 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCAS-A |
| License Number: | 2884A |
| Business Practice Address: | 12640 Southwood Dr Laurinburg, NC - 28352 |
| Business Phone Number: | 9103188555 |
| Business Fax Number: | 9102660093 |
| Mailing Address: | 12640 Southwood Dr, LAURINBURG |
| State: | NC |
| Postal Code: | 283528685 |
| Phone Number: | 9103188555 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2013 |
| NPI Last Update Date: | 06/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2884A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |