Doctor Name: | BIANCA TEETERS |
NPI Number: | 1154787612 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 150435 |
Business Practice Address: | 228 N Barron St Eaton, OH - 453201704 |
Business Phone Number: | 9374567694 |
Business Fax Number: | |
Mailing Address: | 228 N Barron St, EATON |
State: | OH |
Postal Code: | 453201704 |
Phone Number: | 9374567694 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2016 |
NPI Last Update Date: | 01/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 150435 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |