Provider Demographics
NPI:1790019404
Name:DUGANNE, TERRI ELLEN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:ELLEN
Last Name:DUGANNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35031 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3649
Mailing Address - Country:US
Mailing Address - Phone:586-725-5777
Mailing Address - Fax:586-725-2080
Practice Address - Street 1:35031 23 MILE RD
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3649
Practice Address - Country:US
Practice Address - Phone:586-725-5777
Practice Address - Fax:586-725-2080
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010592811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical