Provider Demographics
NPI:1083255137
Name:KNIGHT, TERANDA MICHELL (MS, LCAS-A)
Entity Type:Individual
Prefix:
First Name:TERANDA
Middle Name:MICHELL
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MS, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 J P RD
Mailing Address - Street 2:
Mailing Address - City:WHITAKERS
Mailing Address - State:NC
Mailing Address - Zip Code:27891-9189
Mailing Address - Country:US
Mailing Address - Phone:919-307-9264
Mailing Address - Fax:252-303-5484
Practice Address - Street 1:1857 J P RD
Practice Address - Street 2:
Practice Address - City:WHITAKERS
Practice Address - State:NC
Practice Address - Zip Code:27891-9189
Practice Address - Country:US
Practice Address - Phone:252-969-0752
Practice Address - Fax:252-937-7157
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25175101YA0400X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty