Provider Demographics
NPI:1790229128
Name:MAYBAY, TERESA KEITH (BA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KEITH
Last Name:MAYBAY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 SUNSET BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-2423
Mailing Address - Country:US
Mailing Address - Phone:803-260-5688
Mailing Address - Fax:
Practice Address - Street 1:3937 SUNSET BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-2423
Practice Address - Country:US
Practice Address - Phone:803-260-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker