MEDICARE: TERI TOLBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904003315	VA

General Provider Information

NPI Number	:	1467909713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI TOLBERT

Provider Business Mailing Address
First Line	:	PO BOX 3586
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-7586
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 DAKOTA AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-6911
Country	:	US
Telephone Number	:	804-477-7447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2016
Last Update Date	:	09/03/2016

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Directions to “ TERI TOLBERT ” Practice Location

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