Provider Demographics
NPI:1669995783
Name:GINTHER, TERRA LAQUAY (LMSW)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:LAQUAY
Last Name:GINTHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:LAQUAY
Other - Last Name:PLEINESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 W HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:989-444-9250
Mailing Address - Fax:
Practice Address - Street 1:28800 HARPER AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-350-0013
Practice Address - Fax:586-350-0042
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010997231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical