Provider Demographics
NPI:1427344159
Name:SPAULDING, TERESA ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANNE
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:ANNE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2829 WATT AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6245
Mailing Address - Country:US
Mailing Address - Phone:916-979-3524
Mailing Address - Fax:
Practice Address - Street 1:2829 WATT AVE STE 150
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6245
Practice Address - Country:US
Practice Address - Phone:916-979-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical