Provider Demographics
NPI:1518617737
Name:MISPEROS, THERESA MAE S (CADC-R)
Entity Type:Individual
Prefix:
First Name:THERESA MAE
Middle Name:S
Last Name:MISPEROS
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E ASH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-4097
Mailing Address - Country:US
Mailing Address - Phone:919-583-9329
Mailing Address - Fax:919-583-9328
Practice Address - Street 1:1700 E ASH ST STE 200
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4097
Practice Address - Country:US
Practice Address - Phone:919-583-9329
Practice Address - Fax:919-583-9328
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)