Provider Demographics
NPI:1689038325
Name:TERESA REDFEARN LLC
Entity type:Organization
Organization Name:TERESA REDFEARN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:W
Authorized Official - Last Name:REDFEARN
Authorized Official - Suffix:
Authorized Official - Credentials:LPES, NCSP
Authorized Official - Phone:843-917-0495
Mailing Address - Street 1:718 S 4TH ST
Mailing Address - Street 2:PO BOX 1257
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5724
Mailing Address - Country:US
Mailing Address - Phone:843-917-0495
Mailing Address - Fax:864-751-4179
Practice Address - Street 1:122 E HOME AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-3712
Practice Address - Country:US
Practice Address - Phone:843-917-0495
Practice Address - Fax:864-751-4179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD AND FAMILY RESOURCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-08
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TM1800X
SC4605103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty