Active NPI
Teri Shontelle Macqueen, PH.D.
- Psychologist
- Charlotte, NC
National Provider Identifier
1407912942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2930
- Practice address
- 6733 Fairview Rd
Suite B
Charlotte, NC 28210-3382 - Phone
- (704) 560-0023
- NPI assigned
- Dec 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2930 | NC | Primary |
Addresses
Primary practice location
6733 Fairview Rd
Suite B
Charlotte, NC 28210-3382
Mailing address
6733 Fairview Rd
Suite B
Charlotte, NC 28210-3382
Phone (704) 560-0023
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046ET | Other | NC | BCBS |
| 6000670 | Medicaid | NC | |
| 7040485 | Other | NC | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 23, 2021 through Nov 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2930 | NC | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1407912942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6733 FAIRVIEW RD",
"address_2": "SUITE B",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282103382",
"telephone_number": "704-560-0023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6733 FAIRVIEW RD",
"address_2": "SUITE B",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282103382",
"telephone_number": "704-560-0023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACQUEEN",
"first_name": "TERI",
"middle_name": "SHONTELLE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2930",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "046ET",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000670",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7040485",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.