MEDICARE: TERESIA MEDLEY-HOOD MSW, LCSW

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	1041C0700X	Clinical Social Worker	C011490	NC
3	1041C0700X	Clinical Social Worker
4	163WH0200X	Home Health Registered Nurse	2222222	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730330689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESIA MEDLEY-HOOD MSW, LCSW

Provider Business Mailing Address
First Line	:	3137 AMITY CT
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4935
Country	:	US
Telephone Number	:	704-536-7326
Fax Number	:	704-536-7147

Provider Business Practice Location Address
First Line	:	3137 AMITY CT
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4935
Country	:	US
Telephone Number	:	704-536-7326
Fax Number	:	704-536-7147

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	02/14/2019

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