Provider Demographics
NPI:1588391890
Name:DUCKER, TERESA LYNN (LPC, ACS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:DUCKER
Suffix:
Gender:F
Credentials:LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 KRAMER ST APT B
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3732
Mailing Address - Country:US
Mailing Address - Phone:770-315-4454
Mailing Address - Fax:
Practice Address - Street 1:310 KRAMER ST APT B
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3732
Practice Address - Country:US
Practice Address - Phone:770-315-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health