Provider Demographics
NPI:1164948881
Name:TOLIVER, TERICA G (LCSW)
Entity Type:Individual
Prefix:
First Name:TERICA
Middle Name:G
Last Name:TOLIVER
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 1:17497 HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-2522
Mailing Address - Country:US
Mailing Address - Phone:970-675-8411
Mailing Address - Fax:
Practice Address - Street 1:1300 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2489
Practice Address - Country:US
Practice Address - Phone:225-362-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19013981041C0700X
LA109251041C0700X
MN596001041C0700X
MN287851041C0700X
COCSW.099270081041C0700X
KY2546401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical