Provider Demographics
NPI:1629033006
Name:WEBSTER, TIMOTHY NORRIS (PHD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:NORRIS
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:160 KIMEL FOREST DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-770-6451
Mailing Address - Fax:336-714-6475
Practice Address - Street 1:160 KIMEL FOREST DR
Practice Address - Street 2:STE 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6074
Practice Address - Country:US
Practice Address - Phone:336-770-6451
Practice Address - Fax:336-714-6475
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC635103G00000X, 103T00000X, 103TB0200X, 103TC0700X, 103TH0100X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04862OtherBCBS PROVIDER ID
NC6000280Medicaid