Provider Demographics
NPI:1497455331
Name:ANDERSON, TERENCE GENE
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:GENE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12416 GLADYS RETREAT CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3348
Mailing Address - Country:US
Mailing Address - Phone:202-657-3223
Mailing Address - Fax:
Practice Address - Street 1:12416 GLADYS RETREAT CIR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3348
Practice Address - Country:US
Practice Address - Phone:202-657-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician