Provider Demographics
NPI:1710126735
Name:NASH, TIMOTHY LEE (MSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LEE
Last Name:NASH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20323
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27120-0323
Mailing Address - Country:US
Mailing Address - Phone:336-761-5071
Mailing Address - Fax:336-761-5071
Practice Address - Street 1:115 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3741
Practice Address - Country:US
Practice Address - Phone:336-761-5071
Practice Address - Fax:336-761-5071
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0013371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical