Provider Demographics
NPI:1063606069
Name:TEEGARDEN-CABAY, LISA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:TEEGARDEN-CABAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5165
Mailing Address - Country:US
Mailing Address - Phone:540-387-3977
Mailing Address - Fax:
Practice Address - Street 1:811 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5165
Practice Address - Country:US
Practice Address - Phone:540-387-3977
Practice Address - Fax:540-387-3988
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-02
Last Update Date:2007-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002476103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent