Provider Demographics
NPI:1386201705
Name:STERCK, TERESA JENNETTE (CACI, RP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JENNETTE
Last Name:STERCK
Suffix:
Gender:F
Credentials:CACI, RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3119
Mailing Address - Country:US
Mailing Address - Phone:719-632-3510
Mailing Address - Fax:
Practice Address - Street 1:2565 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3119
Practice Address - Country:US
Practice Address - Phone:719-632-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0108358101Y00000X
COACA.0007666101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor