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General NPI Number Information
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NPI Number | 1881028017
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Entity Type | Individual
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Provider Name | MS. LISA RENEE TERRY
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Gender | Female
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 11795 NORTHFALL LN SUITE 601
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City | ALPHARETTA
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State | GA
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Zip | 30009-7968
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Country | US
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Telephone | 770-645-1733
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Fax | 678-566-0743
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Provider Business Mailing Address
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Address Line | 11795 NORTHFALL LN SUITE 601
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City | ALPHARETTA
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State | GA
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Zip | 30009-7968
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Country | US
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Telephone | 770-645-1733
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Fax | 678-566-0743
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1931
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License Number State | GA
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