Provider Demographics
NPI:1104179357
Name:TARLETON, TERRIE (LPC)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:TARLETON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 ABERCORN ST STE 221
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5714
Mailing Address - Country:US
Mailing Address - Phone:912-200-9818
Mailing Address - Fax:912-200-9819
Practice Address - Street 1:6555 ABERCORN ST. SUITE 221
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-200-9818
Practice Address - Fax:912-200-9819
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional