Provider Demographics
NPI:1558458166
Name:WILSON, TWYLA JOANNA PETERSON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TWYLA
Middle Name:JOANNA PETERSON
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TWYLA
Other - Middle Name:JOANNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:608 BARTLETT CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-6768
Mailing Address - Country:US
Mailing Address - Phone:919-644-6443
Mailing Address - Fax:919-401-5511
Practice Address - Street 1:111 CLOISTER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2295
Practice Address - Country:US
Practice Address - Phone:919-801-9087
Practice Address - Fax:919-403-5511
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007491041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical