Provider Demographics
NPI:1861530479
Name:SIMPSON, WAYNE CARLTON (LPC)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:CARLTON
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 PARK RD
Mailing Address - Street 2:F
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1336
Mailing Address - Country:US
Mailing Address - Phone:704-342-0441
Mailing Address - Fax:
Practice Address - Street 1:1825 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-4008
Practice Address - Country:US
Practice Address - Phone:704-563-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103091Medicaid