Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3169 | NC |
Y | 103T00000X | Psychologist | 3169 | NC |
NPI | 1013936665 |
---|---|
Provider Name | Teresa Klosek |
First Address | Charlotte, NC 28219-9305 |
Second Address | Davidson, NC 28036-8746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 05/01/2022 |