Provider Demographics
NPI:1649849860
Name:GOLDSBY, TE'ERA ANTOINETTE (LLPC)
Entity type:Individual
Prefix:
First Name:TE'ERA
Middle Name:ANTOINETTE
Last Name:GOLDSBY
Suffix:
Gender:
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8243 HALL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5504
Mailing Address - Country:US
Mailing Address - Phone:586-933-5395
Mailing Address - Fax:
Practice Address - Street 1:8243 HALL RD STE 200
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5504
Practice Address - Country:US
Practice Address - Phone:586-933-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451017632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health