Provider Demographics
NPI:1215461553
Name:KLEIN, TERESSA (MA)
Entity type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:TERESSA
Other - Middle Name:
Other - Last Name:GUGINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2716 BRADENTON DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5711
Mailing Address - Country:US
Mailing Address - Phone:941-661-9983
Mailing Address - Fax:
Practice Address - Street 1:235 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5305
Practice Address - Country:US
Practice Address - Phone:336-355-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NCA15339101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist