Provider Demographics
NPI:1972973774
Name:MATHURIN, TERESSA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:
Last Name:MATHURIN
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 1:1948 LEVGARD LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2428
Mailing Address - Country:US
Mailing Address - Phone:404-914-1231
Mailing Address - Fax:
Practice Address - Street 1:200 WESTPARK DR STE 120
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1447
Practice Address - Country:US
Practice Address - Phone:678-383-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional