Provider Demographics
NPI:1669553319
Name:PAINE, TERESA S (PH D)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:S
Last Name:PAINE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0904
Mailing Address - Country:US
Mailing Address - Phone:304-324-0999
Mailing Address - Fax:304-324-0996
Practice Address - Street 1:500 BLAND ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3030
Practice Address - Country:US
Practice Address - Phone:304-324-0999
Practice Address - Fax:304-324-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000903106H00000X
WV251101YP2500X
VA0701001102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001715135OtherMOUNTAIN STATE BLUE CROSS
4639860OtherAETNA BEHAVIORAL HEALTH
379407OtherMAMSI
VA00540435-5Medicaid
VA027550OtherANTHEM BLUE CROSS BLUE SH
WV1039015OtherWV WORKERS' COMP
117043OtherVALUE OPTIONS
255172OtherMAGELLAN EAP