Provider Demographics
NPI:1457785206
Name:GANDY, TERESA RENEE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:RENEE
Last Name:GANDY
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 1:2555 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-7990
Mailing Address - Country:US
Mailing Address - Phone:731-641-4545
Mailing Address - Fax:731-641-4546
Practice Address - Street 1:236 ALTAMONTE BAY CLUB CIR APT 207
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5800
Practice Address - Country:US
Practice Address - Phone:260-341-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)