Provider Demographics
NPI:1275681496
Name:PRITCHARD, TIMOTHY CLARKE (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CLARKE
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1650
Mailing Address - Country:US
Mailing Address - Phone:919-872-5113
Mailing Address - Fax:
Practice Address - Street 1:4016 BARRETT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6623
Practice Address - Country:US
Practice Address - Phone:919-624-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0022391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC69176OtherBLUE CROSS BLUE SHEILD
NC2873538Medicare ID - Type Unspecified