Provider Demographics
NPI:1609366392
Name:TEORA, CHRISTINE L
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:TEORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 BALLY BROOK DR APT 2H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9854
Mailing Address - Country:US
Mailing Address - Phone:585-313-9843
Mailing Address - Fax:
Practice Address - Street 1:84 COURTHOUSE SQ
Practice Address - Street 2:
Practice Address - City:LOVINGSTON
Practice Address - State:VA
Practice Address - Zip Code:22949-2359
Practice Address - Country:US
Practice Address - Phone:434-260-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool