Individual
MISS THERESA ANNE MEDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW CP
Contact information
Practice address
5133 RIVERS AVE, N CHARLESTON, SC 29406-6338
(843) 789-1786
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8561
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SW1420
—
SC
Enumeration date
02/11/2009
Last updated
10/25/2022
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