Provider Demographics
NPI:1407912942
Name:MACQUEEN, TERI SHONTELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:SHONTELLE
Last Name:MACQUEEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6733 FAIRVIEW RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3382
Mailing Address - Country:US
Mailing Address - Phone:704-560-0023
Mailing Address - Fax:
Practice Address - Street 1:6733 FAIRVIEW RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3382
Practice Address - Country:US
Practice Address - Phone:704-560-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2930103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046ETOtherBCBS
NC6000670Medicaid
NC7040485OtherAETNA