Provider Demographics
NPI:1235724345
Name:ANTHONY, TERRESHA (LMSW)
Entity Type:Individual
Prefix:
First Name:TERRESHA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SWEETBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6446
Mailing Address - Country:US
Mailing Address - Phone:404-396-8681
Mailing Address - Fax:
Practice Address - Street 1:3 SWEETBERRY CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-6446
Practice Address - Country:US
Practice Address - Phone:404-396-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0087191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical