MEDICARE: TERI T PERKINS LCSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1093338105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERI T PERKINS LCSW LLC

Provider Business Mailing Address
First Line	:	3814 N 9TH AVE APT D
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2864
Country	:	US
Telephone Number	:	850-501-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 PLANTATION RD STE 11
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6234
Country	:	US
Telephone Number	:	850-501-9950
Fax Number	:	850-373-4767

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TERI THERESA PERKINS
Credential	:	LCSW
Telephone Number	:	850-501-9950

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	11/14/2020

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