Provider Demographics
NPI:1528203502
Name:WEBB, TIMOTHY COLLIER
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:COLLIER
Last Name:WEBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2506 BROOK STONE DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7831
Mailing Address - Country:US
Mailing Address - Phone:336-413-3726
Mailing Address - Fax:
Practice Address - Street 1:2506 BROOK STONE DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-7831
Practice Address - Country:US
Practice Address - Phone:336-413-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional