Provider Demographics
NPI:1467160515
Name:GILLER ETHERIDGE, TERRI JO (LPC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:JO
Last Name:GILLER ETHERIDGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HIGHLAND HTS
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-7306
Mailing Address - Country:US
Mailing Address - Phone:217-204-1562
Mailing Address - Fax:
Practice Address - Street 1:23 HIGHLAND HTS
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-7306
Practice Address - Country:US
Practice Address - Phone:217-204-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2776101Y00000X, 101YM0800X
VA0701010735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor