Provider Demographics
NPI:1790590420
Name:MIDDLETON, THERESE ADELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:ADELE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:ADELE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2535 US HIGHWAY 117 S
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:NC
Mailing Address - Zip Code:28425-7633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2535 US HIGHWAY 117 S
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:NC
Practice Address - Zip Code:28425-7633
Practice Address - Country:US
Practice Address - Phone:910-200-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040115051041C0700X
NCC0121171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical