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NPI Code Detail

MEDICARE: TERI ANN BISTARKEY LCSW

MEDICARE: TERI ANN BISTARKEY LCSW
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
11041C0700XClinical Social Worker0904004677VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21912197559OTHERVANPI

General Provider Information

NPI Number : 1629047865
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERI ANN BISTARKEY LCSW
Provider Business Mailing Address
First Line : PO BOX 876
Second Line :
City : BRACEY
State : VA
Zip : 23919-0876
Country : US
Telephone Number : 434-447-8381
Fax Number : 434-447-8381
Provider Business Practice Location Address
First Line : 314 E ATLANTIC ST
Second Line :
City : SOUTH HILL
State : VA
Zip : 23970-2006
Country : US
Telephone Number : 434-447-8381
Fax Number : 434-447-8381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 10/27/2014

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