Provider Demographics
NPI:1891079398
Name:MARIN, TERI A (LMSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:A
Last Name:MARIN
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 1:5250 NORTHLAND DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1096
Mailing Address - Country:US
Mailing Address - Phone:616-361-5001
Mailing Address - Fax:616-361-2166
Practice Address - Street 1:5250 NORTHLAND DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1096
Practice Address - Country:US
Practice Address - Phone:616-361-5001
Practice Address - Fax:616-361-2166
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical