Provider Demographics
NPI:1508991829
Name:MASSEY, TERRY L (CRTC,LCSW,LISW,CCSOT)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:MASSEY
Suffix:
Gender:M
Credentials:CRTC,LCSW,LISW,CCSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-0178
Mailing Address - Country:US
Mailing Address - Phone:704-491-3097
Mailing Address - Fax:704-625-7129
Practice Address - Street 1:9635 SOUTHERN PINE BLVD STE 127
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5563
Practice Address - Country:US
Practice Address - Phone:704-207-0423
Practice Address - Fax:704-491-3097
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0027981041C0700X
NCC0056771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007186Medicaid