Provider Demographics
NPI:1801812557
Name:MISCO, TERESA GAIL (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:GAIL
Last Name:MISCO
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Gender:F
Credentials:LCSW
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Mailing Address - Street 1:3536 BRAMBLETON AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6526
Mailing Address - Country:US
Mailing Address - Phone:540-776-6466
Mailing Address - Fax:540-981-1705
Practice Address - Street 1:3536 BRAMBLETON AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6526
Practice Address - Country:US
Practice Address - Phone:540-776-6466
Practice Address - Fax:540-981-1705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA09040057981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical