Provider Demographics
NPI:1568583946
Name:PHILLIPS, TERESA L (MA,EDS,LPC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA,EDS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 WILHELM PL NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2534
Mailing Address - Country:US
Mailing Address - Phone:704-795-6100
Mailing Address - Fax:
Practice Address - Street 1:233 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4763
Practice Address - Country:US
Practice Address - Phone:704-783-6044
Practice Address - Fax:704-795-6101
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional