| Doctor Name: | MRS. WANDALYN ISAAC TEAGUE |
| NPI Number: | 1992976054 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC/NCC |
| License Number: | NCC# 95559 |
| Business Practice Address: | 900 Roanoke St Scotland Neck, NC - 27874 |
| Business Phone Number: | 2528260188 |
| Business Fax Number: | |
| Mailing Address: | 900 Roanoke St, SCOTLAND NECK |
| State: | NC |
| Postal Code: | 278741236 |
| Phone Number: | 2528260188 |
| Fax Number: | |
| NPI Enumeration Date: | 03/17/2008 |
| NPI Last Update Date: | 11/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | NCC# 95559 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |