Provider Demographics
NPI:1609494665
Name:RITTINGER, TERESA WILSON (LLMFT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:WILSON
Last Name:RITTINGER
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1227
Mailing Address - Country:US
Mailing Address - Phone:734-478-6079
Mailing Address - Fax:
Practice Address - Street 1:28900 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9241
Practice Address - Country:US
Practice Address - Phone:248-560-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151000537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist