Provider Demographics
NPI:1740482462
Name:FAHEY, TERI-LEA COSCIA (MA, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TERI-LEA
Middle Name:COSCIA
Last Name:FAHEY
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12107 AUTUMN WINDS LN
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-9238
Mailing Address - Country:US
Mailing Address - Phone:704-541-6297
Mailing Address - Fax:
Practice Address - Street 1:12107 AUTUMN WINDS LN
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-9238
Practice Address - Country:US
Practice Address - Phone:704-541-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional