Provider Demographics
NPI:1902203052
Name:GINGERELLA, TERESA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:GINGERELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:REIDVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29375-0763
Mailing Address - Country:US
Mailing Address - Phone:904-207-8295
Mailing Address - Fax:864-877-2473
Practice Address - Street 1:269 S CHURCH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3496
Practice Address - Country:US
Practice Address - Phone:904-207-8295
Practice Address - Fax:864-877-2473
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional