Provider Demographics
NPI:1114900917
Name:BRADY, TERESA BENNETT (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:BENNETT
Last Name:BRADY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 NOLAND WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0243
Mailing Address - Country:US
Mailing Address - Phone:704-321-2597
Mailing Address - Fax:
Practice Address - Street 1:1025 MOREHEAD MEDICAL ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2839
Practice Address - Country:US
Practice Address - Phone:704-355-3149
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS