Provider Demographics
NPI:1912746553
Name:CULVER, TERICA TERIA (MA, APC)
Entity type:Individual
Prefix:
First Name:TERICA
Middle Name:TERIA
Last Name:CULVER
Suffix:
Gender:F
Credentials:MA, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6667 SHADY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5729
Mailing Address - Country:US
Mailing Address - Phone:404-483-4024
Mailing Address - Fax:
Practice Address - Street 1:6667 SHADY RIDGE LN
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-5729
Practice Address - Country:US
Practice Address - Phone:404-483-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008590101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional