Provider Demographics
NPI:1538246012
Name:RADKE, WILLIAM JAMES (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:RADKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1727
Mailing Address - Country:US
Mailing Address - Phone:919-821-0790
Mailing Address - Fax:919-861-8961
Practice Address - Street 1:401 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1727
Practice Address - Country:US
Practice Address - Phone:919-821-0790
Practice Address - Fax:919-861-8961
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0030621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003332Medicaid
NC11359OtherBCBS PROVIDER NUMBER
NC11359OtherBCBS PROVIDER NUMBER