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General NPI Number Information
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NPI Number | 1184372914
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Entity Type | Organization
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Legal Business Name | MILICIA A. TEDDER
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 115 E HARDEN ST STE 103
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City | GRAHAM
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State | NC
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Zip | 27253-3001
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Country | US
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Telephone | 336-569-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 4093 DUNKIRK DR
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City | BURLINGTON
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State | NC
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Zip | 27215-0106
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Country | US
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Telephone | 919-697-1674
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Fax |
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Authorized Official
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Title or Position | LPA
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Name | MILICIA TEDDER
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Credential |
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Telephone | 336-569-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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