Provider Demographics
NPI:1184340424
Name:WEAVER, TERESE LATRECE (APCC)
Entity type:Individual
Prefix:
First Name:TERESE
Middle Name:LATRECE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 MIRTO CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4414
Mailing Address - Country:US
Mailing Address - Phone:661-281-7611
Mailing Address - Fax:
Practice Address - Street 1:1430 TRUXTUN AVE STE 700
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5226
Practice Address - Country:US
Practice Address - Phone:661-717-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional