=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033306089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA MARIE MEFFORD L.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 11/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 WINTON BLOUNT LOOP
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-239-9106
-----------------------------------------------------
Fax | 334-239-9104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14931 FEATHERCHASE DR
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-489-0149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0629
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2763
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701003832
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------