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General NPI Number Information
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NPI Number | 1518165554
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Entity Type | Individual
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Provider Name | CYNTHIA ANN TEAGUE RN, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 236 LE PHILLIP CT NE STE K
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City | CONCORD
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State | NC
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Zip | 28025-1917
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Country | US
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Telephone | 704-782-1020
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Fax | 704-782-1184
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Provider Business Mailing Address
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Address Line | 4386 GREYGATE ST SW
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City | CONCORD
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State | NC
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Zip | 28027-8702
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Country | US
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Telephone | 704-795-9784
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Fax | 704-782-1184
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 91348
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7455
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License Number State | NC
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