Provider Demographics
NPI:1467441303
Name:HOPSON, TERESIA (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESIA
Middle Name:
Last Name:HOPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERESIA
Other - Middle Name:
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46624-1171
Mailing Address - Country:US
Mailing Address - Phone:574-226-2934
Mailing Address - Fax:
Practice Address - Street 1:323 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1913
Practice Address - Country:US
Practice Address - Phone:574-256-7006
Practice Address - Fax:574-256-2266
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004883A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000320433OtherANTHEM
IN000000320433OtherANTHEM