Provider Demographics
NPI:1790722510
Name:TEAGARDEN, VONNIE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VONNIE
Middle Name:MARIE
Last Name:TEAGARDEN
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 1:64 N RICHHILL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1306
Mailing Address - Country:US
Mailing Address - Phone:724-852-1614
Mailing Address - Fax:724-852-1614
Practice Address - Street 1:64 N RICHHILL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1306
Practice Address - Country:US
Practice Address - Phone:724-852-1614
Practice Address - Fax:724-852-1614
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0122521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004479EMedicaid
PA118496OtherMHN
PA165765OtherVALUE OPTIONS
PA004479EMedicaid
PA118496OtherMHN