Provider Demographics
NPI:1376086066
Name:TERRELL, NASHAWNA LONGENESE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NASHAWNA
Middle Name:LONGENESE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3907
Mailing Address - Country:US
Mailing Address - Phone:773-238-1100
Mailing Address - Fax:773-238-4095
Practice Address - Street 1:11111 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3907
Practice Address - Country:US
Practice Address - Phone:773-238-1100
Practice Address - Fax:773-238-4095
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0172501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical