Provider Demographics
NPI:1114891223
Name:PFAB, TERESA MARIE (LSC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:PFAB
Suffix:
Gender:F
Credentials:LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12463 LEMON CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4127
Mailing Address - Country:US
Mailing Address - Phone:619-390-2527
Mailing Address - Fax:
Practice Address - Street 1:12463 LEMON CREST DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-4127
Practice Address - Country:US
Practice Address - Phone:619-390-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250171247101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool