Provider Demographics
NPI:1831213222
Name:BELL, TWYNA L (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:TWYNA
Middle Name:L
Last Name:BELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VALENCIA DRIVE NC
Mailing Address - Street 2:SUITE 160
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8351
Mailing Address - Country:US
Mailing Address - Phone:910-353-2853
Mailing Address - Fax:
Practice Address - Street 1:200 VALENCIA DR
Practice Address - Street 2:SUITE 160
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6311
Practice Address - Country:US
Practice Address - Phone:910-353-2853
Practice Address - Fax:910-383-6561
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103217Medicaid