Provider Demographics
NPI:1942537584
Name:MURCH, THERESA CARROLL (LPC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:CARROLL
Last Name:MURCH
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 1:224 GREAT BRIDGE BLVD
Mailing Address - Street 2:#2
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3904
Mailing Address - Country:US
Mailing Address - Phone:757-819-6117
Mailing Address - Fax:757-819-6149
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:#2
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-819-6117
Practice Address - Fax:757-819-6149
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004628101YP2500X
TX19194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional