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General NPI Number Information
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NPI Number | 1669553319
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Entity Type | Individual
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Provider Name | TERESA S. PAINE PH. D.
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Gender | Female
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 500 BLAND ST
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City | BLUEFIELD
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State | WV
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Zip | 24701-3030
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Country | US
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Telephone | 304-324-0999
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Fax | 304-324-0996
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Provider Business Mailing Address
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Address Line | PO BOX 904
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City | BLUEFIELD
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State | WV
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Zip | 24701-0904
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Country | US
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Telephone | 304-324-0999
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Fax | 304-324-0996
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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 | 0717000903
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License Number State | VA
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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 | 251
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701001102
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License Number State | VA
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