Teresa A Poole, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1791 Issued in NC

Practice address

692 N Spence Ave
Suite B
Goldsboro, NC 27534-4339

Phone

(919) 778-8757

Fax

(919) 778-8758

NPI assigned

Feb 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Waynesboro Family ClinicGroup PAC ID 3274445903, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Waynesboro Family Clinic

  • Mental Health Counselor
  • Goldsboro, NC
  • NPI 1760417570

  NC

  Medicare reassignment Care Compare group NPD
• Teresa a. Poole, PH.D., PA

  • Clinical Psychologist
  • Goldsboro, NC
  • NPI 1336343664

  Clinical

  NPD (past) Authorized official
• Wayne Cares Inc.

  • Voluntary or Charitable Agency
  • Goldsboro, NC
  • NPI 1518414465
  NPD (past)
• Wellsprings Center of Goldsboro,P.a.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Goldsboro, NC
  • NPI 1023096088
  NPD (past)

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1790757698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "692 N SPENCE AVE",
            "address_2": "SUITE B",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344339",
            "telephone_number": "919-778-8757",
            "fax_number": "919-778-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692 N SPENCE AVE",
            "address_2": "SUITE B",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344339",
            "telephone_number": "919-778-8757",
            "fax_number": "919-778-8758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "TERESA",
        "middle_name": "A",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0473E",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "E1424",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000096",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sierra Rose Poelstra, DDS
• Gary L Poland
• Teresa Dawn Polizzi
• Joseph W Ponzi, MD
• Daniel Thomas Poole, M.D.
• Debra Carol Porter, M.S., CCC-SLP
• Positive Beginnings Community Center, LLC
• Jennifer Potter, NP
• Christopher C. Potts, D.M.D.
• Frederick L Potts, M.D.

• All providers in Goldsboro, NC
• Clinical Psychologist in North Carolina

• 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.