Provider Demographics
NPI:1942712641
Name:MCCORMICK-DUNLAP, THERESA WILHELMENA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:WILHELMENA
Last Name:MCCORMICK-DUNLAP
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 BEATTIES FORD RD STE 107-114
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2859
Mailing Address - Country:US
Mailing Address - Phone:704-891-5694
Mailing Address - Fax:
Practice Address - Street 1:1428 ELLEN ST STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5286
Practice Address - Country:US
Practice Address - Phone:704-891-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0120021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical