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1558458166 NPI number — TWYLA JOANNA PETERSON WILSON LCSW

NPI Number: 1558458166
Health Care Provider/Practitioner: TWYLA JOANNA PETERSON WILSON LCSW

Information about “1558458166” NPI (TWYLA JOANNA PETERSON WILSON LCSW) exists in 1558458166 in HTML format HTML  |  1558458166 in plain Text format TXT  |  1558458166 in PDF (Portable Document Format) PDF  |  1558458166 in an XML format XML  formats.

NPI Number : 1558458166 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558458166",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "TWYLA",
    "MiddleName": "JOANNA PETERSON",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILSON",
    "OtherFirstName": "TWYLA",
    "OtherMiddleName": "JOANNE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "608 BARTLETT CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HILLSBOROUGH",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27278-6768",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-644-6443",
    "MailingAddressFaxNumber": "919-401-5511",
    "FirstLinePracticeLocationAddress": "111 CLOISTER CT",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "CHAPEL HILL",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27514-2295",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-801-9087",
    "PracticeLocationAddressFaxNumber": "919-403-5511",
    "EnumerationDate": "10/06/2006",
    "LastUpdateDate": "11/28/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "C000749",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "C000749",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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