Provider Demographics
NPI:1225450448
Name:SMOAK, TERESA (MS, LPC, MAC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SMOAK
Suffix:
Gender:F
Credentials:MS, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 UNIVERSITY PARKWAY
Mailing Address - Street 2:MAILBOX 15
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6389
Mailing Address - Country:US
Mailing Address - Phone:803-641-3609
Mailing Address - Fax:
Practice Address - Street 1:471 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6399
Practice Address - Country:US
Practice Address - Phone:803-641-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009247101YM0800X
AZLPC-23581101YM0800X
SC6327101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health