Provider Demographics
NPI:1881028017
Name:TERRY, LISA RENEE
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11795 NORTHFALL LN
Mailing Address - Street 2:SUITE 601
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7968
Mailing Address - Country:US
Mailing Address - Phone:770-645-1733
Mailing Address - Fax:678-566-0743
Practice Address - Street 1:11795 NORTHFALL LN
Practice Address - Street 2:SUITE 601
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7968
Practice Address - Country:US
Practice Address - Phone:770-645-1733
Practice Address - Fax:678-566-0743
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional