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General NPI Number Information
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NPI Number | 1124390984
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Entity Type | Individual
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Provider Name | TERESA FLANAGAN MATRE' MSW, LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 28 WALNUT ST SUITE #6
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City | WAYNESVILLE
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State | NC
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Zip | 28786-3245
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Country | US
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Telephone | 828-400-5538
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Fax |
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Provider Business Mailing Address
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Address Line | 7171 WOODLAND AVE APT. 211
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City | WEST DES MOINES
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State | IA
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Zip | 50266-7208
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Country | US
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Telephone | 847-975-5269
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1390
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License Number State | NC
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