Provider Demographics
NPI:1649720913
Name:SAMUELS, TERRY (PHD, MS, LPC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:PHD, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ARROWHEAD BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1113
Mailing Address - Country:US
Mailing Address - Phone:770-893-8044
Mailing Address - Fax:
Practice Address - Street 1:224 ARROWHEAD BLVD STE 101
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1113
Practice Address - Country:US
Practice Address - Phone:770-893-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical