Provider Demographics
NPI:1033584255
Name:EVANS, TERESA P (LPC #4643)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:P
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC #4643
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:PASCHAL
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-#4643
Mailing Address - Street 1:1115 DUNLAP RD
Mailing Address - Street 2:STRESS MANAGEMENT CENTER AT FERNVIEW
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2501
Mailing Address - Country:US
Mailing Address - Phone:864-225-0792
Mailing Address - Fax:864-226-3968
Practice Address - Street 1:1115 DUNLAP RD
Practice Address - Street 2:STRESS MANAGEMENT CENTER AT FERNVIEW
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2501
Practice Address - Country:US
Practice Address - Phone:864-225-0792
Practice Address - Fax:864-226-3968
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional