Healthcare Provider Details

I. General information

NPI: 1609811256
Provider Name (Legal Business Name): TIMOTHY PAUL WAMPLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SUNNYBROOK RD
RALEIGH NC
27610-1829
US

IV. Provider business mailing address

4812 MORNING MIST CT
APEX NC
27539-8114
US

V. Phone/Fax

Practice location:
  • Phone: 919-212-0129
  • Fax: 919-255-1540
Mailing address:
  • Phone: 919-303-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003113
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: