Provider Demographics
NPI:1649767518
Name:BILLINGTON, TERRI L (SAC-IT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BILLINGTON
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1106 LUCERNE LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NESHKORO
Mailing Address - State:WI
Mailing Address - Zip Code:54960-6408
Mailing Address - Country:US
Mailing Address - Phone:920-252-9733
Mailing Address - Fax:
Practice Address - Street 1:400 S TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-6922
Practice Address - Country:US
Practice Address - Phone:920-787-5514
Practice Address - Fax:920-787-4737
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18550-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)