Provider Demographics
NPI:1740579549
Name:TEAL PEOPLES, HOLISTIC COUNSELING & CONSULTATION, PLLC
Entity Type:Organization
Organization Name:TEAL PEOPLES, HOLISTIC COUNSELING & CONSULTATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEAL
Authorized Official - Middle Name:VENICE
Authorized Official - Last Name:PEOPLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, CSI LISW
Authorized Official - Phone:704-449-9666
Mailing Address - Street 1:5909 EDINBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2254
Mailing Address - Country:US
Mailing Address - Phone:888-502-9591
Mailing Address - Fax:888-502-9591
Practice Address - Street 1:2750 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4285
Practice Address - Country:US
Practice Address - Phone:888-502-9591
Practice Address - Fax:888-502-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1429101YA0400X
1041C0700X
NCC006557251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5869Medicaid
SCSW1056Medicaid
NC6008501Medicaid
NC6112081Medicaid