Provider Demographics
NPI:1316504772
Name:SEARLES, THERESA MARIE (LPCC, 12851)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:SEARLES
Suffix:
Gender:F
Credentials:LPCC, 12851
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14850 HIGHWAY 4 STE A145
Mailing Address - Street 2:
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-2282
Mailing Address - Country:US
Mailing Address - Phone:925-450-2313
Mailing Address - Fax:
Practice Address - Street 1:2926 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4924
Practice Address - Country:US
Practice Address - Phone:925-450-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health