Provider Demographics
NPI:1881963916
Name:TEAGLE, CYNTHIA ANN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:ANN
Last Name:TEAGLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-2125
Mailing Address - Country:US
Mailing Address - Phone:757-848-1158
Mailing Address - Fax:
Practice Address - Street 1:8 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-2125
Practice Address - Country:US
Practice Address - Phone:757-848-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040077611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical