Provider Demographics
NPI:1619012739
Name:TERRY, NANCY S (MA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:TERRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8617
Mailing Address - Fax:
Practice Address - Street 1:112 JOHN ST
Practice Address - Street 2:STE 102
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1472
Practice Address - Country:US
Practice Address - Phone:864-442-7585
Practice Address - Fax:864-859-9648
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional