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Individual
TIMOTHY JERREAL WOOTEN
Active
Individual
TIMOTHY JERREAL WOOTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCMHC-A, LCAS-A, NCC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
25834
NC
101YM0800X
Mental Health Counselor
Primary
A15640
NC
Other
Enumeration date
05/11/2020
Last updated
05/11/2020
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