Provider Demographics
NPI:1033470463
Name:WEST, TEOLETTA SUZETTE (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:TEOLETTA
Middle Name:SUZETTE
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 CALDWELL LOOP
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-1400
Mailing Address - Country:US
Mailing Address - Phone:910-459-3902
Mailing Address - Fax:
Practice Address - Street 1:533 CALDWELL LOOP
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-1400
Practice Address - Country:US
Practice Address - Phone:910-459-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20564101YA0400X
NCP0067171041C0700X
NCC0092901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)