Provider Demographics
NPI:1144802455
Name:WIMBUSH, TERRI SHAWANDA (LPC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:SHAWANDA
Last Name:WIMBUSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BENTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4780
Mailing Address - Country:US
Mailing Address - Phone:804-252-9558
Mailing Address - Fax:
Practice Address - Street 1:1100 BENTBROOK DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-4780
Practice Address - Country:US
Practice Address - Phone:804-252-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional