Provider Demographics
NPI:1528457611
Name:UTLEY-MCKOY, TESHIA J'WAN (MS)
Entity type:Individual
Prefix:MS
First Name:TESHIA
Middle Name:J'WAN
Last Name:UTLEY-MCKOY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1409
Mailing Address - Country:US
Mailing Address - Phone:919-815-8778
Mailing Address - Fax:
Practice Address - Street 1:324 SNEED LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-4915
Practice Address - Country:US
Practice Address - Phone:919-815-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health