Provider Demographics
NPI:1083788954
Name:HUEHOLT, THERESE M (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:M
Last Name:HUEHOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1343
Mailing Address - Country:US
Mailing Address - Phone:910-790-5921
Mailing Address - Fax:910-794-1036
Practice Address - Street 1:33 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1343
Practice Address - Country:US
Practice Address - Phone:910-790-5921
Practice Address - Fax:910-794-1036
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC353752084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC44376OtherBLUE CROSS NORTH CAROLINA
NC8944376Medicaid
NC2175618CMedicare ID - Type Unspecified
NC44376OtherBLUE CROSS NORTH CAROLINA