Timothy Jerreal Wooten, LCMHC-A, LCAS-A, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A15640 Issued in NC

Practice address

3708 Lyckan Pkwy Ste 205
Durham, NC 27707-2586

Phone

(919) 809-9846

Fax

(919) 516-0057

NPI assigned

May 11, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1679195960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 BALMORAY CT APT 5",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072004",
            "telephone_number": "336-504-3384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3708 LYCKAN PKWY STE 205",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072586",
            "telephone_number": "919-809-9846",
            "fax_number": "919-516-0057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOTEN",
        "first_name": "TIMOTHY",
        "middle_name": "JERREAL",
        "credential": "LCMHC-A, LCAS-A, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "25834",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A15640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Ann Woolfson, NP
• Laura Dacus Wooten, M.S.W., LCSW
• Laura Oliver Wooten, LCSW
• Mahagani Rose Wooten
• Octavia Wooten
• Tonya D Wooten, LMBT
• Words Spoken E
• Jamie O. Workman, PH.D.
• World Relief Corporation of National Association of Evangelicals
• Gordon Worley, M.D.

• Mental Health Counselor in Durham, NC
• Providers in Durham, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.