Provider Demographics
NPI:1821468232
Name:PERKINS, TEDRA (LMFT)
Entity Type:Individual
Prefix:
First Name:TEDRA
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TEDRA
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1885 NORTH DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7773
Mailing Address - Country:US
Mailing Address - Phone:404-694-8703
Mailing Address - Fax:
Practice Address - Street 1:1919 JOHN WESLEY AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3605
Practice Address - Country:US
Practice Address - Phone:404-762-9191
Practice Address - Fax:404-762-9101
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000402106H00000X
GAMFT001549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist