Provider Demographics
NPI:1699370627
Name:TERRELL, TANESHA (LLMSW)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30061 JOHN RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-1818
Mailing Address - Country:US
Mailing Address - Phone:586-746-4297
Mailing Address - Fax:
Practice Address - Street 1:30061 JOHN RIVERS DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048-1818
Practice Address - Country:US
Practice Address - Phone:586-746-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011080761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical