Healthcare Provider Details

I. General information

NPI: 1962116350
Provider Name (Legal Business Name): TEINESHA RYSHEK SMALLWOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 WAKE FOREST RD STE 349
RALEIGH NC
27609-0010
US

IV. Provider business mailing address

PO BOX 44
WINDSOR NC
27983-0044
US

V. Phone/Fax

Practice location:
  • Phone: 252-513-0443
  • Fax: 252-307-6566
Mailing address:
  • Phone: 252-287-6353
  • Fax: 252-307-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018378
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: