Individual provider Active NPI

Teresa W Redfearn, MS, LPES, NCSP

  • Psychologist
  • Hartsville, SC
National Provider Identifier
1053674143
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4605
Practice address
122 E Home Ave
Hartsville, SC 29550-3712
Phone
(843) 917-0495
Fax
(864) 751-4179
NPI assigned
Jun 22, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X
Intellectual & Developmental Disabilities Psychologist 103TM1800X 4605 SC
Psychologist 103T00000X 4605 Primary

Addresses

Primary practice location

122 E Home Ave
Hartsville, SC 29550-3712

Mailing address

PO Box 1257
Hartsville, SC 29551-1257
Phone (843) 917-0495

Other identifiers 3

IdentifierTypeStateIssuer
LP1000MedicaidSC
45-5198811OtherSCEPI
4605MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Teresa Redfearn LLC Psychologist CurrentSince Mar 30, 2025 Accepting new patients

Locations

718 S 4th St
Hartsville, SC 29550
Phone (843) 917-0495

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1053674143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1257",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511257",
            "telephone_number": "843-917-0495",
            "fax_number": "864-751-4179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E HOME AVE",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295503712",
            "telephone_number": "843-917-0495",
            "fax_number": "864-751-4179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDFEARN",
        "first_name": "TERESA",
        "middle_name": "W",
        "credential": "MS, LPES, NCSP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-22",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "SC",
            "license": "4605",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": "4605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LP1000",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EPI",
            "identifier": "45-5198811",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4605",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartsville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.