MEDICARE: TEAL PEOPLES, HOLISTIC COUNSELING & CONSULTATION, PLLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1429	NC
2	251S00000X	Community/Behavioral Health Agency	C006557	NC
3	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740579549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAL PEOPLES, HOLISTIC COUNSELING & CONSULTATION, PLLC

Provider Business Mailing Address
First Line	:	5909 EDINBOROUGH DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2254
Country	:	US
Telephone Number	:	888-502-9591
Fax Number	:	888-502-9591

Provider Business Practice Location Address
First Line	:	2750 E WT HARRIS BLVD
Second Line	:	SUITE 201
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4285
Country	:	US
Telephone Number	:	888-502-9591
Fax Number	:	888-502-9591

Authorized Official
Title or Position	:	CLINICAL DIRECTOR/OWNER
Name	:	MRS. TEAL VENICE PEOPLES
Credential	:	LCSW, LCAS, CSI LISW
Telephone Number	:	704-449-9666

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	01/13/2015

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