Provider Demographics
NPI:1942828397
Name:HENNEGAN, THERESA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HENNEGAN
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 OLD WELL ST APT I
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0010
Mailing Address - Country:US
Mailing Address - Phone:704-430-5897
Mailing Address - Fax:
Practice Address - Street 1:9705 NORTHEAST PKWY STE 102
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9704
Practice Address - Country:US
Practice Address - Phone:704-430-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management