Provider Demographics
NPI:1417056086
Name:VODDEN, TERI HEALY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:HEALY
Last Name:VODDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:THERESE
Other - Middle Name:JEAN
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2107 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501
Mailing Address - Country:US
Mailing Address - Phone:707-840-0815
Mailing Address - Fax:
Practice Address - Street 1:2107 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-840-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS123011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical