Provider Demographics
NPI:1851449144
Name:TREW, THERESA MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARY
Last Name:TREW
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 1:1318 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3314
Mailing Address - Country:US
Mailing Address - Phone:805-541-2300
Mailing Address - Fax:805-541-2301
Practice Address - Street 1:1318 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3314
Practice Address - Country:US
Practice Address - Phone:805-541-2300
Practice Address - Fax:805-541-2301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS12155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional