Provider Demographics
NPI:1043528383
Name:TERRY, PORSCHE MONIC (LCSW)
Entity type:Individual
Prefix:MS
First Name:PORSCHE
Middle Name:MONIC
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PORSCHE
Other - Middle Name:M
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6949 SADDLEBACK PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4853
Mailing Address - Country:US
Mailing Address - Phone:909-353-3760
Mailing Address - Fax:877-357-2847
Practice Address - Street 1:6949 SADDLEBACK PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-4853
Practice Address - Country:US
Practice Address - Phone:909-353-3760
Practice Address - Fax:877-357-2847
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW28940101YM0800X
CA646831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health