Provider Demographics
NPI:1285840710
Name:HAEGER, TERESSA F (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESSA
Middle Name:F
Last Name:HAEGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:HAEGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0009
Mailing Address - Country:US
Mailing Address - Phone:706-864-0186
Mailing Address - Fax:706-864-0963
Practice Address - Street 1:81 CROWN MOUNTAIN PL
Practice Address - Street 2:SUITE C200
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1627
Practice Address - Country:US
Practice Address - Phone:706-864-0186
Practice Address - Fax:706-864-0963
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGSFMedicare ID - Type Unspecified
GAS18498Medicare UPIN