Provider Demographics
NPI:1073663126
Name:WINN, TERESA IRENE (LPC, MAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:IRENE
Last Name:WINN
Suffix:
Gender:F
Credentials:LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1133
Mailing Address - Country:US
Mailing Address - Phone:912-489-9808
Mailing Address - Fax:912-369-2030
Practice Address - Street 1:115 NORTHSIDE DRIVE
Practice Address - Street 2:SUITE 115 WEST PARK PROFESSIONALS
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4591
Practice Address - Country:US
Practice Address - Phone:912-489-9802
Practice Address - Fax:912-369-2030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional