Provider Demographics
NPI:1083597066
Name:DULA, TESHIA STOVALL (EDD, LPC)
Entity type:Individual
Prefix:
First Name:TESHIA
Middle Name:STOVALL
Last Name:DULA
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 CHADBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7130
Mailing Address - Country:US
Mailing Address - Phone:770-633-6153
Mailing Address - Fax:
Practice Address - Street 1:1530 CHADBERRY WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7130
Practice Address - Country:US
Practice Address - Phone:770-633-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional