Provider Demographics
NPI:1962980904
Name:TERRY, TYBREISHA KEIANNA (LCSWA)
Entity type:Individual
Prefix:MS
First Name:TYBREISHA
Middle Name:KEIANNA
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 GUILFORD COLLEGE RD APT D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2074
Mailing Address - Country:US
Mailing Address - Phone:919-641-6753
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3709
Practice Address - Country:US
Practice Address - Phone:336-907-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0125481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical