Provider Demographics
NPI:1477890531
Name:GENBERG, THERESA M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:GENBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:BANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:116 LOW COUNTRY LOOP
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7050
Mailing Address - Country:US
Mailing Address - Phone:412-916-1957
Mailing Address - Fax:843-650-0647
Practice Address - Street 1:116 LOW COUNTRY LOOP
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7050
Practice Address - Country:US
Practice Address - Phone:412-916-1957
Practice Address - Fax:843-650-0647
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7933101YP2500X
PAPC006724101YP2500X
PACO161724L101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional