Active NPI
Timothy M Wilder, LPC
- Professional Counselor
- Roanoke, VA
National Provider Identifier
1568446144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701002845
- Practice address
- 4656 Brambleton Ave
Roanoke, VA 24018-3437 - Phone
- (540) 772-8043
- Fax
- (540) 772-8242
- NPI assigned
- Dec 6, 2005
- Last updated
- Jul 13, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701002845 | VA | Primary |
Addresses
Primary practice location
4656 Brambleton Ave
Roanoke, VA 24018-3437
Mailing address
4656 Brambleton Ave
Roanoke, VA 24018-3437
Phone (540) 772-8043
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 272041 | Other | VA | MAMSI |
| 199752 | Other | VA | MANAGED HEALTH NETWORK |
| 272041 | Other | VA | ALLIANCE |
| 465418 | Other | VA | VALUE OPTIONS |
| 7335124 | Other | VA | AETNA |
| 253575 | Other | VA | ANTHEM BCBS |
| 2041553 | Other | VA | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701002845 | VA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1568446144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4656 BRAMBLETON AVE",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240183437",
"telephone_number": "540-772-8043",
"fax_number": "540-772-8242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4656 BRAMBLETON AVE",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240183437",
"telephone_number": "540-772-8043",
"fax_number": "540-772-8242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "TIMOTHY",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-06",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701002845",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "272041",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "199752",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALLIANCE",
"identifier": "272041",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "465418",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7335124",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "253575",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2041553",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.