Provider Demographics
NPI:1427430750
Name:SMITH, TERESA LYNNE (CSAC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 BREEZEWOOD DR
Mailing Address - Street 2:APT. 203
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2564
Mailing Address - Country:US
Mailing Address - Phone:919-631-5181
Mailing Address - Fax:
Practice Address - Street 1:4150 BREEZEWOOD DR
Practice Address - Street 2:APT. 203
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2564
Practice Address - Country:US
Practice Address - Phone:919-631-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-15758101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)