Provider Demographics
NPI:1336479005
Name:TERRY, JOANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:TERRY
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 1:22220 QUAIL RUN CIR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-2608
Mailing Address - Country:US
Mailing Address - Phone:248-446-3094
Mailing Address - Fax:
Practice Address - Street 1:22220 QUAIL RUN CIR UNIT 1
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-2608
Practice Address - Country:US
Practice Address - Phone:248-446-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-01
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016192103K00000X, 283Q00000X, 1041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No283Q00000XHospitalsPsychiatric Hospital
No251S00000XAgenciesCommunity/Behavioral Health