DEPARTMENT OF INSURANCE

Name	Waller, Theresa	DOIID	767581	NAIC NPN	10366260

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/2/2018		9/30/2025
Active	Non Resident	Agent	Life	10/2/2018		9/30/2025
Inactive	Non Resident	Agent	Personal Lines	8/6/2014	9/30/2015

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	4301 Morris Park Drive Mint Hill, NC 28227
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(855) 448-3386