MEDICARE: TWAYLA EASON MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C006261	NC

General Provider Information

NPI Number	:	1588809883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TWAYLA EASON MSW, LCSW

Provider Business Mailing Address
First Line	:	925 SPRING FOREST RD
Second Line	:	APARTMENT 3
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2106
Country	:	US
Telephone Number	:	252-531-1442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 E FIRE TOWER RD
Second Line	:	SUITE 113
City	:	GREENVILLE
State	:	NC
Zip	:	27858-4194
Country	:	US
Telephone Number	:	252-355-5587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	01/14/2009

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