Provider Demographics
NPI:1740402882
Name:TERRY, LOLETIA (BA, ACIT)
Entity Type:Individual
Prefix:MRS
First Name:LOLETIA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:BA, ACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 E VILLAGE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9085
Mailing Address - Country:US
Mailing Address - Phone:317-566-9361
Mailing Address - Fax:
Practice Address - Street 1:2626 E 46TH ST
Practice Address - Street 2:SUITE J
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2380
Practice Address - Country:US
Practice Address - Phone:317-475-9066
Practice Address - Fax:317-257-3602
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)