Healthcare Provider Details

I. General information

NPI: 1457068827
Provider Name (Legal Business Name): TERESA LYNN BRANNON WVCPRSS SUD/MH THD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 VIRGINIA ST E
CHARLESTON WV
25301-2170
US

IV. Provider business mailing address

304 S HEBER ST
BECKLEY WV
25801-5423
US

V. Phone/Fax

Practice location:
  • Phone: 681-710-3578
  • Fax:
Mailing address:
  • Phone: 681-319-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number22-992
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: