Provider Demographics
NPI:1225450448
Name:SMOAK, TERESA ANN (MS, LPC, MAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:SMOAK
Suffix:
Gender:F
Credentials:MS, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3187
Mailing Address - Country:US
Mailing Address - Phone:803-278-0880
Mailing Address - Fax:803-278-6791
Practice Address - Street 1:431 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3187
Practice Address - Country:US
Practice Address - Phone:803-278-0880
Practice Address - Fax:803-278-6791
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009247101YM0800X
SC6327101YM0800X
GAAPC004207101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health