Provider Demographics
NPI:1073803946
Name:GUNKEL, TERRI LISA (CSC-ADP)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LISA
Last Name:GUNKEL
Suffix:
Gender:F
Credentials:CSC-ADP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 980
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0980
Mailing Address - Country:US
Mailing Address - Phone:410-535-5400
Mailing Address - Fax:410-535-0736
Practice Address - Street 1:975 SOLOMONS ISLAND ROAD N
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-0980
Practice Address - Country:US
Practice Address - Phone:410-535-5400
Practice Address - Fax:410-535-0736
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)