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General NPI Number Information
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NPI Number | 1053674143
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Entity Type | Individual
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Provider Name | TERESA W REDFEARN MS, LPES, NCSP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 122 E HOME AVE
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City | HARTSVILLE
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State | SC
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Zip | 29550-3712
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Country | US
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Telephone | 843-917-0495
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Fax | 864-751-4179
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Provider Business Mailing Address
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Address Line | PO BOX 1257
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City | HARTSVILLE
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State | SC
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Zip | 29551-1257
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Country | US
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Telephone | 843-917-0495
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Fax | 864-751-4179
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 4605
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4605
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License Number State |
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