Healthcare Provider Details

I. General information

NPI: 1447174107
Provider Name (Legal Business Name): TIMOLISHA SWINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

IV. Provider business mailing address

511 DUGGINS WAY APT A
FAYETTEVILLE NC
28312-6227
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-1733
  • Fax:
Mailing address:
  • Phone: 910-670-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: