Provider Demographics
NPI:1154641694
Name:BRANCH, TERESA W (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:W
Last Name:BRANCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4900
Mailing Address - Country:US
Mailing Address - Phone:706-569-7992
Mailing Address - Fax:706-569-8560
Practice Address - Street 1:7020 MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4900
Practice Address - Country:US
Practice Address - Phone:706-569-7992
Practice Address - Fax:706-569-8560
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0031901041C0700X
AL1506C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical