Provider Demographics
NPI:1235615352
Name:WILLIAMS-GLASS, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:WILLIAMS-GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 CEDARBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2033
Mailing Address - Country:US
Mailing Address - Phone:205-317-9451
Mailing Address - Fax:
Practice Address - Street 1:3432 CEDARBROOK CIR
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2033
Practice Address - Country:US
Practice Address - Phone:205-317-9451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional