Provider Demographics
NPI:1528467107
Name:WISNIEWSKI, TERRY LYNN (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LYNN
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 HANNAN RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-9721
Mailing Address - Country:US
Mailing Address - Phone:586-563-8985
Mailing Address - Fax:
Practice Address - Street 1:2889 HANNAN RD
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-9721
Practice Address - Country:US
Practice Address - Phone:586-563-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL304731101YP2500X
MI6401014294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional