Provider Demographics
NPI:1295282309
Name:MAYLE, TERESA C (MSRC, LPCA)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:C
Last Name:MAYLE
Suffix:
Gender:F
Credentials:MSRC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 JACKSON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2600
Mailing Address - Country:US
Mailing Address - Phone:252-308-0744
Mailing Address - Fax:252-308-0092
Practice Address - Street 1:608 JACKSON ST
Practice Address - Street 2:SUITE F
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2600
Practice Address - Country:US
Practice Address - Phone:252-308-0744
Practice Address - Fax:252-308-0092
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11353101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional