Provider Demographics
NPI:1760775902
Name:POINDEXTER, TERESA (MED)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-5352
Mailing Address - Country:US
Mailing Address - Phone:662-302-8631
Mailing Address - Fax:
Practice Address - Street 1:1742 CHERYL ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7218
Practice Address - Country:US
Practice Address - Phone:662-627-7267
Practice Address - Fax:662-627-5240
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health