Provider Demographics
NPI:1164432373
Name:TERRELL, JAMES KENNETH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KENNETH
Last Name:TERRELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 46TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5170
Mailing Address - Country:US
Mailing Address - Phone:205-348-7236
Mailing Address - Fax:205-348-9368
Practice Address - Street 1:2501 WOODLAND RD
Practice Address - Street 2:2501 WOODLAND ROAD
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5028
Practice Address - Country:US
Practice Address - Phone:205-348-7236
Practice Address - Fax:205-348-9368
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1235C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6232084OtherUNITED BEHAVIORAL HEALTH