Provider Demographics
NPI:1518165554
Name:TEAGUE, CYNTHIA ANN (RN, LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4386 GREYGATE ST SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8702
Mailing Address - Country:US
Mailing Address - Phone:704-795-9784
Mailing Address - Fax:704-782-1184
Practice Address - Street 1:236 LE PHILLIP CT NE STE K
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1917
Practice Address - Country:US
Practice Address - Phone:704-782-1020
Practice Address - Fax:704-782-1184
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91348163WP0809X
NC7455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult