Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 635 | NC |
N | 103TC0700X | Clinical Psychologist | 635 | NC |
Y | 102L00000X | Psychologist | 635 | NC |
Y | 103T00000X | Psychologist | 635 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 635 | NC |
N | 103G00000X | Clinical Psychologist | 635 | NC |
N | 103TC0700X | Clinical Psychologist | 635 | NC |
N | 103TH0100X | Health Service | 635 | NC |
N | 103TP2701X | Group Psychotherapist | 635 | NC |
N | 103TR0400X | Rehabilitation Psychologist | 635 | NC |
NPI | 1629033006 |
---|---|
Provider Name | Dr. Timothy Norris Webster |
First Address | Winston Salem, NC 27103-6074 |
Second Address | Winston Salem, NC 27103-6074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 18/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04862 | BCBS PROVIDER ID (01) | NC |
6000280 | (05) | NC |