Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 11750 | NC |
NPI | 1760931489 |
---|---|
Provider Name | Teresa Dawn Polizzi |
First Address | Goldsboro, NC 27530-1078 |
Second Address | Goldsboro, NC 27530-1078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2016 |
Last Update Date | 11/01/2022 |