Provider Demographics
NPI:1215374269
Name:TERRY, JAMIE (LLMSW, QMRP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:LLMSW, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5095 VAN SLYKE RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3959
Mailing Address - Country:US
Mailing Address - Phone:810-234-7080
Mailing Address - Fax:810-235-4999
Practice Address - Street 1:5095 VAN SLYKE RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3959
Practice Address - Country:US
Practice Address - Phone:810-234-7080
Practice Address - Fax:810-235-4999
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker