Provider Demographics
NPI:1568818912
Name:TEAGUE, ADRIANNE (LPC, LCASA)
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:LPC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14526 WATSON SEED FARM RD.
Mailing Address - Street 2:
Mailing Address - City:WHITAKERS
Mailing Address - State:NC
Mailing Address - Zip Code:27891
Mailing Address - Country:US
Mailing Address - Phone:252-813-2077
Mailing Address - Fax:
Practice Address - Street 1:60 N HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-6619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12307101Y00000X
NC23222101YA0400X
NC12307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)