Provider Demographics
NPI:1114572781
Name:TWEED, MICHAL KELLY ELIZABETH
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:KELLY ELIZABETH
Last Name:TWEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 E JACKSON BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-9629
Mailing Address - Country:US
Mailing Address - Phone:910-897-2008
Mailing Address - Fax:
Practice Address - Street 1:596 E JACKSON BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-9629
Practice Address - Country:US
Practice Address - Phone:910-897-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)