Provider Demographics
NPI:1679459788
Name:HARDEN, TIMOTHY JUSTIN
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JUSTIN
Last Name:HARDEN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5355
Mailing Address - Country:US
Mailing Address - Phone:743-255-4568
Mailing Address - Fax:
Practice Address - Street 1:720 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5355
Practice Address - Country:US
Practice Address - Phone:743-255-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-25-1745-753777106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician