Provider Demographics
NPI:1558598169
Name:BRUNSON-DOLL, TERRA L (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:L
Last Name:BRUNSON-DOLL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:
Other - Last Name:BRUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3163
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-268-2377
Practice Address - Street 1:2860 NORTHPARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-9700
Practice Address - Country:US
Practice Address - Phone:260-356-2875
Practice Address - Fax:260-356-0611
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005737A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical