Provider Demographics
NPI:1811327562
Name:FENDERSON, TERRENCE (MSW)
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:
Last Name:FENDERSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7718
Mailing Address - Country:US
Mailing Address - Phone:504-231-1775
Mailing Address - Fax:504-301-0752
Practice Address - Street 1:2736 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7718
Practice Address - Country:US
Practice Address - Phone:504-231-1775
Practice Address - Fax:504-301-0752
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker