Provider Demographics
NPI:1992281349
Name:TEEL, TYISHA TAMAR (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:TYISHA
Middle Name:TAMAR
Last Name:TEEL
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 TEELS LN
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-7671
Mailing Address - Country:US
Mailing Address - Phone:252-342-0234
Mailing Address - Fax:
Practice Address - Street 1:3332 BRIDGES ST STE 3A
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3296
Practice Address - Country:US
Practice Address - Phone:888-557-1675
Practice Address - Fax:252-648-7598
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0124911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical