Healthcare Provider Details

I. General information

NPI: 1164369187
Provider Name (Legal Business Name): LAUREN MARIE TEDDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARIE BROOKS

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 E MAIN ST
ABINGDON VA
24210-3408
US

IV. Provider business mailing address

1638 CAROLINA AVE
BRISTOL TN
37620-5121
US

V. Phone/Fax

Practice location:
  • Phone: 540-240-9029
  • Fax:
Mailing address:
  • Phone: 276-356-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020320
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: