Provider Demographics
NPI:1548027287
Name:AYCOCK, SERENA (CASE MANGER)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:CASE MANGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LOGGER CT
Mailing Address - Street 2:SUITE 102-E
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-900-7200
Mailing Address - Fax:
Practice Address - Street 1:1100 LOGGER CT STE E102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8510
Practice Address - Country:US
Practice Address - Phone:919-900-7200
Practice Address - Fax:919-670-5001
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator