Provider Demographics
NPI:1598122285
Name:TERRY L. CHAPMAN, LLC
Entity Type:Organization
Organization Name:TERRY L. CHAPMAN, LLC
Other - Org Name:TLC COLLABORATIVE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SINGLE PROVIDER LLC
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:681-404-6094
Mailing Address - Street 1:118 ADAMS ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2841
Mailing Address - Country:US
Mailing Address - Phone:681-404-6094
Mailing Address - Fax:681-404-6494
Practice Address - Street 1:118 ADAMS ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2841
Practice Address - Country:US
Practice Address - Phone:681-404-6094
Practice Address - Fax:681-404-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009436871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty