Provider Demographics
NPI:1336343664
Name:TERESA A. POOLE, PH.D., PA
Entity type:Organization
Organization Name:TERESA A. POOLE, PH.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-778-8757
Mailing Address - Street 1:692 N SPENCE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4339
Mailing Address - Country:US
Mailing Address - Phone:919-778-8757
Mailing Address - Fax:919-778-8758
Practice Address - Street 1:692 N SPENCE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4339
Practice Address - Country:US
Practice Address - Phone:919-778-8757
Practice Address - Fax:919-778-8758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000096Medicaid
NC0473EOtherBLUE CROSS BLUE SHIELD
NC2814249CMedicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
NC2346209Medicare ID - Type UnspecifiedGROUP PRICING NUMBER