=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003730789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD G TEDESCHI PHD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2026
-----------------------------------------------------
Last Update Date | 08/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 236 LE PHILLIP CT NE STE D
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-614-1565
-----------------------------------------------------
Fax | 704-342-1884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 LE PHILLIP CT NE STE D
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-614-1565
-----------------------------------------------------
Fax | 704-342-1884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD G TEDESCHI
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 704-614-1565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------