Provider Demographics
NPI:1578225421
Name:PAZ, TERESITA DANIELA (LCSWA)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:DANIELA
Last Name:PAZ
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 OWEN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3412
Mailing Address - Country:US
Mailing Address - Phone:910-273-1393
Mailing Address - Fax:
Practice Address - Street 1:1830 OWEN DR STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3412
Practice Address - Country:US
Practice Address - Phone:910-273-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0167581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical