Provider Demographics
NPI:1033270210
Name:BONDURANT, TERESA NEWSOME (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:NEWSOME
Last Name:BONDURANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:IRENE
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:985 9TH AVE SOUTHWEST
Mailing Address - Street 2:SUITE 201 POB
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022
Mailing Address - Country:US
Mailing Address - Phone:205-481-9339
Mailing Address - Fax:
Practice Address - Street 1:985 9TH AVE SOUTHWEST
Practice Address - Street 2:SUITE 201 POB
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022
Practice Address - Country:US
Practice Address - Phone:205-481-9339
Practice Address - Fax:205-481-8558
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL592103T00000X
NC1302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R92770Medicare UPIN
51504095Medicare ID - Type Unspecified