Provider Demographics
NPI:1942367065
Name:TUTWILER, CAROLYN MARIE (MHDL, LCAS, CCS)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:TUTWILER
Suffix:
Gender:F
Credentials:MHDL, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 PECAN LN
Mailing Address - Street 2:ALLIED BEHAVIORAL MANAGMENT, INC.
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2949
Mailing Address - Country:US
Mailing Address - Phone:910-640-2021
Mailing Address - Fax:910-640-2022
Practice Address - Street 1:603 PECAN LN
Practice Address - Street 2:ALLIED BEHAVIORAL MANAGEMENT, INC.
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2949
Practice Address - Country:US
Practice Address - Phone:910-640-2021
Practice Address - Fax:910-640-2022
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC422101YA0400X, 101YM0800X
NC273101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110501Medicaid