Healthcare Provider Details

I. General information

NPI: 1144806746
Provider Name (Legal Business Name): KATIE TERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 BRACKENDALE RD NW
KENNESAW GA
30152-7746
US

IV. Provider business mailing address

711 PEAR GROVE PL
MARIETTA GA
30066-5826
US

V. Phone/Fax

Practice location:
  • Phone: 678-304-8788
  • Fax:
Mailing address:
  • Phone: 678-304-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW007418
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007418
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: