Healthcare Provider Details

I. General information

NPI: 1518165554
Provider Name (Legal Business Name): CYNTHIA ANN TEAGUE RN, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 LE PHILLIP CT NE STE K
CONCORD NC
28025-1917
US

IV. Provider business mailing address

4386 GREYGATE ST SW
CONCORD NC
28027-8702
US

V. Phone/Fax

Practice location:
  • Phone: 704-782-1020
  • Fax: 704-782-1184
Mailing address:
  • Phone: 704-795-9784
  • Fax: 704-782-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number91348
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7455
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: