Provider Demographics
NPI:1205990090
Name:KING, TEANN MARIE (MA LPC)
Entity type:Individual
Prefix:MISS
First Name:TEANN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAIN STREET
Mailing Address - Street 2:SUITE 708 MULL CENTER
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-232-7232
Mailing Address - Fax:304-232-7245
Practice Address - Street 1:1025 MAIN STREET
Practice Address - Street 2:SUITE 708 MULL CENTER
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-232-7232
Practice Address - Fax:304-232-7245
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP012621Medicare PIN