Provider Demographics
NPI:1477837144
Name:TWILLEY, CAROL J (EDS)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:TWILLEY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:GAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:2150 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6662
Mailing Address - Country:US
Mailing Address - Phone:901-353-5440
Mailing Address - Fax:901-353-5464
Practice Address - Street 1:2150 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6662
Practice Address - Country:US
Practice Address - Phone:901-353-5440
Practice Address - Fax:901-353-5464
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker