Provider Demographics
NPI:1760158802
Name:BISHOP, TERESA LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 CURTIS PKWY NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2063
Mailing Address - Country:US
Mailing Address - Phone:706-602-9546
Mailing Address - Fax:706-602-0765
Practice Address - Street 1:197 CURTIS PKWY NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2063
Practice Address - Country:US
Practice Address - Phone:706-602-9546
Practice Address - Fax:706-602-0765
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical