Provider Demographics
NPI:1144844804
Name:AINSWORTH, TERRY COLLINS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:COLLINS
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42484 BLYTH AVE
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-5498
Mailing Address - Country:US
Mailing Address - Phone:985-974-0429
Mailing Address - Fax:
Practice Address - Street 1:787 N 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3115
Practice Address - Country:US
Practice Address - Phone:985-974-0429
Practice Address - Fax:504-294-8310
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA65411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical