Provider Demographics
NPI:1962655746
Name:THEOHARES, TERESA LINNE MCCARTY (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LINNE MCCARTY
Last Name:THEOHARES
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N. JAMES RD.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5610
Mailing Address - Fax:614-388-7302
Practice Address - Street 1:420 N. JAMES RD.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5610
Practice Address - Fax:614-388-7302
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008940 SUPV104100000X
C-SWHC1041C0700X
OHLISW-SI.0008940104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical