Provider Demographics
NPI:1073615142
Name:TERRACINA, AMY DAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DAYE
Last Name:TERRACINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 SAN FELIPE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3907
Mailing Address - Country:US
Mailing Address - Phone:713-626-7990
Mailing Address - Fax:713-627-7715
Practice Address - Street 1:700 S. WESTGREEN BLVD.
Practice Address - Street 2:INTERFACE-SAMARITAN COUNSELING CENTERS, INC.
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:713-626-7990
Practice Address - Fax:713-627-7715
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLCSW2839104100000X
TXLCSW549641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker