Healthcare Provider Details

I. General information

NPI: 1245159649
Provider Name (Legal Business Name): JACK RUSTIN TURNWALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COMMONWEALTH CT STE B
CARY NC
27511-4437
US

IV. Provider business mailing address

102 COMMONWEALTH CT STE B
CARY NC
27511-4437
US

V. Phone/Fax

Practice location:
  • Phone: 828-515-1246
  • Fax:
Mailing address:
  • Phone: 828-515-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023974
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: