Provider Demographics
NPI:1730330689
Name:MEDLEY-HOOD, TERESIA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TERESIA
Middle Name:
Last Name:MEDLEY-HOOD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 AMITY CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4935
Mailing Address - Country:US
Mailing Address - Phone:704-536-7326
Mailing Address - Fax:704-536-7147
Practice Address - Street 1:3137 AMITY CT
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4935
Practice Address - Country:US
Practice Address - Phone:704-536-7326
Practice Address - Fax:704-536-7147
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
NCC0114901041C0700X
NC2222222163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0000000Medicaid