Provider Demographics
NPI:1154787943
Name:FILLINGIM, THERESA (MDIV, LPC, CACII)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:FILLINGIM
Suffix:
Gender:F
Credentials:MDIV, LPC, CACII
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:HAMLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MDIV, LPC, CACII
Mailing Address - Street 1:102 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1812
Mailing Address - Country:US
Mailing Address - Phone:678-229-8176
Mailing Address - Fax:
Practice Address - Street 1:102 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1812
Practice Address - Country:US
Practice Address - Phone:678-229-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1978101YA0400X
GA101YP1600X
GALPC010751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral