Basic Information
| Provider Information | |||||||||
| NPI: | 1518165554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEAGUE | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4386 GREYGATE ST SW | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280278702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047959784 | ||||||||
| FaxNumber: | 7047821184 | ||||||||
| Practice Location | |||||||||
| Address1: | 236 LE PHILLIP CT NE STE K | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047821020 | ||||||||
| FaxNumber: | 7047821184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 91348 | CO | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 101YP2500X | 7455 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.