Provider Demographics
NPI:1720294283
Name:THOMSEN, TERRI MARIE MAYER (LADC)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:MARIE MAYER
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:MARIE
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:36 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1103
Mailing Address - Country:US
Mailing Address - Phone:802-349-7017
Mailing Address - Fax:802-264-8546
Practice Address - Street 1:27A MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1317
Practice Address - Country:US
Practice Address - Phone:802-349-7017
Practice Address - Fax:802-264-8546
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000407101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)