Provider Demographics
NPI:1760776280
Name:BAUERT, TERRI WOODFORD (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:WOODFORD
Last Name:BAUERT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3238
Mailing Address - Country:US
Mailing Address - Phone:336-209-0081
Mailing Address - Fax:336-299-2083
Practice Address - Street 1:515 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5194
Practice Address - Country:US
Practice Address - Phone:336-209-0081
Practice Address - Fax:336-299-2083
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0034821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical