Provider Demographics
NPI:1689890113
Name:TEEL, ROSALINA
Entity Type:Individual
Prefix:MS
First Name:ROSALINA
Middle Name:
Last Name:TEEL
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 1:404 E POWELL ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3518
Mailing Address - Country:US
Mailing Address - Phone:910-592-7451
Mailing Address - Fax:910-221-5479
Practice Address - Street 1:404 E POWELL ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3518
Practice Address - Country:US
Practice Address - Phone:910-592-7451
Practice Address - Fax:910-221-5479
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-056320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301828Medicaid