Provider Demographics
NPI:1245335561
Name:WISE, TERESA N (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:N
Last Name:WISE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 STRICKLAND RD STE 114297
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5212
Mailing Address - Country:US
Mailing Address - Phone:919-395-9618
Mailing Address - Fax:
Practice Address - Street 1:13200 STRICKLAND RD STE 114297
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-5212
Practice Address - Country:US
Practice Address - Phone:919-395-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical