Provider Demographics
NPI:1285750893
Name:THIERRY, LERA SHANTI (MA)
Entity type:Individual
Prefix:MRS
First Name:LERA
Middle Name:SHANTI
Last Name:THIERRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:LERA
Other - Middle Name:SHANTI
Other - Last Name:EDMUNDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:213 ARBOR FALLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8055
Mailing Address - Country:US
Mailing Address - Phone:803-736-3169
Mailing Address - Fax:803-736-3169
Practice Address - Street 1:2715 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6818
Practice Address - Country:US
Practice Address - Phone:803-898-4777
Practice Address - Fax:803-898-4855
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor