Provider Demographics
NPI: | 1023026044 |
---|---|
Name: | TERRY, DAWN MICHELLE (LCSW) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | DAWN |
Middle Name: | MICHELLE |
Last Name: | TERRY |
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: | 6603 IRONGATE SQUARE |
Mailing Address - Street 2: | CHESTERFIELD FAMILY GUIDANCE CENTER |
Mailing Address - City: | RICHMOND |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23234-6076 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-743-0960 |
Mailing Address - Fax: | 804-743-1175 |
Practice Address - Street 1: | 6603 IRONGATE SQUARE |
Practice Address - Street 2: | CHESTERFIELD FAMILY GUIDANCE CENTER |
Practice Address - City: | RICHMOND |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23234-6076 |
Practice Address - Country: | US |
Practice Address - Phone: | 804-743-0960 |
Practice Address - Fax: | 804-743-1175 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-04 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0904005771 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
082181M | Other | SENTARA | |
172421 | Other | ANTHEM | |
082181M | Other | SENTARA | |
172421 | Other | ANTHEM |