Provider Demographics
NPI:1336106509
Name:TEICHNER, ALBERT GORDON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:GORDON
Last Name:TEICHNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3588
Mailing Address - Country:US
Mailing Address - Phone:843-849-9913
Mailing Address - Fax:843-881-6876
Practice Address - Street 1:222 W COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3588
Practice Address - Country:US
Practice Address - Phone:843-849-9913
Practice Address - Fax:843-881-6876
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-29
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPSO324Medicaid
SCPSO324Medicaid