Healthcare Provider Details

I. General information

NPI: 1295420537
Provider Name (Legal Business Name): TERESA PHIFER JUDY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S HAYNE ST STE 100
MONROE NC
28112-5505
US

IV. Provider business mailing address

802 GW BROOME RD
MONROE NC
28112-9611
US

V. Phone/Fax

Practice location:
  • Phone: 980-269-7822
  • Fax:
Mailing address:
  • Phone: 980-269-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: