Provider Demographics
NPI:1689825226
Name:TEAGUE, LARONYA NICOLE (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:LARONYA
Middle Name:NICOLE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1621
Mailing Address - Country:US
Mailing Address - Phone:336-333-6853
Mailing Address - Fax:336-333-6815
Practice Address - Street 1:715 N EUGENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1621
Practice Address - Country:US
Practice Address - Phone:336-333-6853
Practice Address - Fax:336-333-6815
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health