Provider Demographics
NPI:1063926277
Name:GRODY, TERI A (LMSW)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:A
Last Name:GRODY
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:A
Other - Last Name:LAMIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2514 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-9344
Mailing Address - Country:US
Mailing Address - Phone:231-676-0889
Mailing Address - Fax:
Practice Address - Street 1:2514 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659-9344
Practice Address - Country:US
Practice Address - Phone:231-676-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010991391041C0700X
MI68011037851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical