Provider Demographics
NPI:1205593803
Name:BRIGGS, TERESA LAVERNE (DIRECT SUPPORT PROF)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LAVERNE
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:DIRECT SUPPORT PROF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 HARMONY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4535
Mailing Address - Country:US
Mailing Address - Phone:828-384-3636
Mailing Address - Fax:
Practice Address - Street 1:10950 HARMONY GLEN CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4535
Practice Address - Country:US
Practice Address - Phone:828-384-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87-3346736374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide