Provider Demographics
NPI:1760972046
Name:TEETOR, BRANDI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:
Last Name:TEETOR
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 1:801 OBERLIN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1172
Mailing Address - Country:US
Mailing Address - Phone:336-567-2277
Mailing Address - Fax:
Practice Address - Street 1:801 OBERLIN RD STE 310
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605
Practice Address - Country:US
Practice Address - Phone:336-567-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0113611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical