Provider Demographics
NPI:1154688877
Name:CRUMP, TERRY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
Last Name:CRUMP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 POWERS FERRY RD SE STE B
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7589
Mailing Address - Country:US
Mailing Address - Phone:678-815-7700
Mailing Address - Fax:
Practice Address - Street 1:134 POWERS FERRY RD SE STE B
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7589
Practice Address - Country:US
Practice Address - Phone:678-815-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical