Provider Demographics
NPI:1679975346
Name:WITHERSPOON, TERRY (LPC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:WITHERSPOON
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 1:2811 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2346
Mailing Address - Country:US
Mailing Address - Phone:269-213-9426
Mailing Address - Fax:
Practice Address - Street 1:1750 E GRAND RIVER AVE STE 101
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4958
Practice Address - Country:US
Practice Address - Phone:269-213-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013063101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor