1558458166 NPI number — MS. TWYLA JOANNA PETERSON WILSON LCSW

Table of content: MS. TWYLA JOANNA PETERSON WILSON LCSW (NPI 1558458166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558458166 NPI number — MS. TWYLA JOANNA PETERSON WILSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
TWYLA
Provider Middle Name:
JOANNA PETERSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
TWYLA
Provider Other Middle Name:
JOANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558458166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 BARTLETT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27278-6768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-644-6443
Provider Business Mailing Address Fax Number:
919-401-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CLOISTER CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27514-2295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-801-9087
Provider Business Practice Location Address Fax Number:
919-403-5511
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C000749 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: C000749 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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