MEDICARE: MRS. KATHERINE DUCKETT TEDESCHI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	7615	SC

General Provider Information

NPI Number	:	1295247021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE DUCKETT TEDESCHI

Provider Business Mailing Address
First Line	:	201 CAROLINA POINT PKWY APT 828
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6575
Country	:	US
Telephone Number	:	864-518-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	405A E 1ST AVE
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3062
Country	:	US
Telephone Number	:	864-383-1605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	09/24/2020

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