Provider Demographics
NPI:1043672496
Name:GAITER, TERRON E (LISW, LICDC)
Entity Type:Individual
Prefix:MR
First Name:TERRON
Middle Name:E
Last Name:GAITER
Suffix:
Gender:M
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9743 WOODMILL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3725
Mailing Address - Country:US
Mailing Address - Phone:513-687-0838
Mailing Address - Fax:
Practice Address - Street 1:3650 MUDDY CREEK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2057
Practice Address - Country:US
Practice Address - Phone:513-347-0375
Practice Address - Fax:513-347-0376
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.161097101YA0400X
WVAP00943993104100000X
OHI.22034901041C0700X
OHI2203490251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical