Provider Demographics
NPI:1154436376
Name:TINDALL, TERESA WHITLEY (LPC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:WHITLEY
Last Name:TINDALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 N POINT BLVD STE 231
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3288
Mailing Address - Country:US
Mailing Address - Phone:336-896-0065
Mailing Address - Fax:336-896-0710
Practice Address - Street 1:8025 N POINT BLVD STE 231
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3288
Practice Address - Country:US
Practice Address - Phone:336-896-0065
Practice Address - Fax:336-896-0710
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health