Provider Demographics
NPI:1477617363
Name:TERRELL, CHRSITINE D
Entity Type:Individual
Prefix:
First Name:CHRSITINE
Middle Name:D
Last Name:TERRELL
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 1:11700 HIGHWAY 142
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-0923
Mailing Address - Country:US
Mailing Address - Phone:770-784-5682
Mailing Address - Fax:770-784-3187
Practice Address - Street 1:175 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3317
Practice Address - Country:US
Practice Address - Phone:770-784-3188
Practice Address - Fax:770-784-3187
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health