Provider Demographics
NPI:1235754110
Name:SPAIN, TERRI G (LICSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:G
Last Name:SPAIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12039 OLDE SOUTH LN
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-2335
Mailing Address - Country:US
Mailing Address - Phone:205-213-3409
Mailing Address - Fax:
Practice Address - Street 1:12039 OLDE SOUTH LN
Practice Address - Street 2:
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-2335
Practice Address - Country:US
Practice Address - Phone:205-213-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4309C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical