Provider Demographics
NPI:1306445309
Name:WORTHY, TERESA NICOLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:NICOLE
Last Name:WORTHY
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 1:6690 ROSE LN # B
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-9201
Mailing Address - Country:US
Mailing Address - Phone:601-479-6474
Mailing Address - Fax:
Practice Address - Street 1:6690 ROSE LN # B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MS
Practice Address - Zip Code:39342-9201
Practice Address - Country:US
Practice Address - Phone:601-479-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional