Provider Demographics
NPI:1336850445
Name:SNOW, TERESA TONTA MICHELLE
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:TONTA MICHELLE
Last Name:SNOW
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:605 ATHENS HWY UNIT 5-201
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4767
Mailing Address - Country:US
Mailing Address - Phone:678-598-6006
Mailing Address - Fax:
Practice Address - Street 1:605 ATHENS HWY UNIT 5-201
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4767
Practice Address - Country:US
Practice Address - Phone:678-598-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional