Healthcare Provider Details

I. General information

NPI: 1376290049
Provider Name (Legal Business Name): TERESA LYNN DURSTINE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 01/09/2024
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 ROCKINGHAM RD
ROCKINGHAM NC
28379-3615
US

IV. Provider business mailing address

509 CONRAD HARCOURT WAY
RUSHVILLE IN
46173-1165
US

V. Phone/Fax

Practice location:
  • Phone: 910-562-9882
  • Fax: 910-562-9955
Mailing address:
  • Phone: 765-389-0880
  • Fax: 765-932-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17570
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: