Provider Demographics
NPI:1508315367
Name:TERRELL, ALTHEA ELAINE
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:ELAINE
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 1:17 AUBURNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1401
Mailing Address - Country:US
Mailing Address - Phone:857-891-7031
Mailing Address - Fax:
Practice Address - Street 1:81 BRIDGE ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1270
Practice Address - Country:US
Practice Address - Phone:978-459-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health