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General NPI Number Information
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NPI Number | 1467160515
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Entity Type | Individual
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Provider Name | TERRI JO GILLER ETHERIDGE LPC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 23 HIGHLAND HTS
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City | WHEELING
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State | WV
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Zip | 26003-7306
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Country | US
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Telephone | 217-204-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 23 HIGHLAND HTS
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City | WHEELING
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State | WV
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Zip | 26003-7306
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Country | US
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Telephone | 217-204-1562
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2776
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701010735
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2776
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License Number State | WV
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