Provider Demographics
NPI:1124390984
Name:MATRE', TERESA FLANAGAN (MSW, LMFT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:FLANAGAN
Last Name:MATRE'
Suffix:
Gender:F
Credentials:MSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 WOODLAND AVE
Mailing Address - Street 2:APT. 211
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7208
Mailing Address - Country:US
Mailing Address - Phone:847-975-5269
Mailing Address - Fax:
Practice Address - Street 1:28 WALNUT ST
Practice Address - Street 2:SUITE #6
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3245
Practice Address - Country:US
Practice Address - Phone:828-400-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist