Provider Demographics
NPI:1497304851
Name:SEAGLE, TELISHA (LPCA)
Entity Type:Individual
Prefix:
First Name:TELISHA
Middle Name:
Last Name:SEAGLE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-8470
Mailing Address - Country:US
Mailing Address - Phone:704-472-8383
Mailing Address - Fax:
Practice Address - Street 1:311 MCBEE ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2818
Practice Address - Country:US
Practice Address - Phone:704-466-0162
Practice Address - Fax:828-286-9512
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional