Provider Demographics
NPI:1265848394
Name:TERRY, NATASHA NICOLE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BISSELL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1815
Mailing Address - Country:US
Mailing Address - Phone:510-235-1516
Mailing Address - Fax:510-235-2025
Practice Address - Street 1:2500 BISSELL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1815
Practice Address - Country:US
Practice Address - Phone:510-235-1516
Practice Address - Fax:510-235-2025
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health