Provider Demographics
NPI:1750976726
Name:WAYMAN, TERESA DAWN (MED)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DAWN
Last Name:WAYMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 KANAWHA BLVD E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2413
Mailing Address - Country:US
Mailing Address - Phone:981-830-4347
Mailing Address - Fax:304-347-9820
Practice Address - Street 1:1510 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2413
Practice Address - Country:US
Practice Address - Phone:304-347-9818
Practice Address - Fax:304-347-9820
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WV2805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator