Provider Demographics
NPI:1174052757
Name:AYEWOH, TERI (LMSW, CAMS-11)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:AYEWOH
Suffix:
Gender:F
Credentials:LMSW, CAMS-11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8486 CAMPBELLTON STREET
Mailing Address - Street 2:SUITE 1013
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7257
Mailing Address - Country:US
Mailing Address - Phone:678-907-7088
Mailing Address - Fax:
Practice Address - Street 1:1919 JOHN WESLEY AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3605
Practice Address - Country:US
Practice Address - Phone:404-762-9190
Practice Address - Fax:404-762-9101
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health