Healthcare Provider Details

I. General information

NPI: 1255939211
Provider Name (Legal Business Name): TERESA FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 STATE RD
CHERAW SC
29520-2130
US

IV. Provider business mailing address

PO BOX 1090
HARTSVILLE SC
29551-1090
US

V. Phone/Fax

Practice location:
  • Phone: 843-537-0908
  • Fax: 843-537-0961
Mailing address:
  • Phone: 843-857-0111
  • Fax: 843-309-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number207164
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16444
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: