Provider Demographics
NPI:1457668584
Name:DOWNCEROUX, TERESEA LYNN
Entity Type:Individual
Prefix:MRS
First Name:TERESEA
Middle Name:LYNN
Last Name:DOWNCEROUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7728 INVERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4930
Mailing Address - Country:US
Mailing Address - Phone:904-317-9091
Mailing Address - Fax:
Practice Address - Street 1:7728 INVERMERE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4930
Practice Address - Country:US
Practice Address - Phone:904-317-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029591401Medicaid