MEDICARE: TERI E LAYZELL MSW, 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
1	1041C0700X	Clinical Social Worker	C001322	NC

General Provider Information

NPI Number	:	1710151709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI E LAYZELL MSW, LCSW

Provider Business Mailing Address
First Line	:	413 WILBY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-4701
Country	:	US
Telephone Number	:	704-661-5991
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 WILBY DRIVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-4701
Country	:	US
Telephone Number	:	704-661-5991
Fax Number	:

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	11/17/2011

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