Healthcare Provider Details

I. General information

NPI: 1285565721
Provider Name (Legal Business Name): TERRI H. DUDA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 KENTUCKY ST
SCOTTDALE GA
30079-1124
US

IV. Provider business mailing address

1868 GORDON MNR NE
ATLANTA GA
30307-2319
US

V. Phone/Fax

Practice location:
  • Phone: 404-444-8792
  • Fax:
Mailing address:
  • Phone: 404-444-8792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010334
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: