Provider Demographics
NPI:1831648468
Name:ANDERSON, TERESA (EDD, LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 STEAM ENGINE WAY NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1594
Mailing Address - Country:US
Mailing Address - Phone:470-535-7351
Mailing Address - Fax:
Practice Address - Street 1:1414 STEAM ENGINE WAY NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1594
Practice Address - Country:US
Practice Address - Phone:770-262-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003459101YP2500X
GALPC009315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional