| Doctor Name: | TERRI L WISE |
| NPI Number: | 1326434382 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 08418 |
| Business Practice Address: | 1011 Main St Hampstead, MD - 210742230 |
| Business Phone Number: | 4105529007 |
| Business Fax Number: | 4105529881 |
| Mailing Address: | 1381 Jay Rd, ELDERSBURG |
| State: | MD |
| Postal Code: | 217846115 |
| Phone Number: | 4105529007 |
| Fax Number: | 4105529881 |
| NPI Enumeration Date: | 04/07/2015 |
| NPI Last Update Date: | 04/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 08418 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |