Provider Demographics
NPI:1558082297
Name:TERRY, CHRISTIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:TERRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4415 JUNCTION PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2263
Mailing Address - Country:US
Mailing Address - Phone:910-791-6277
Mailing Address - Fax:910-791-6226
Practice Address - Street 1:4415 JUNCTION PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2263
Practice Address - Country:US
Practice Address - Phone:910-791-6277
Practice Address - Fax:910-791-6226
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist