Provider Demographics
NPI:1629452016
Name:NEWELL, TERRY MICHAEL JR (FBPPC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MICHAEL
Last Name:NEWELL
Suffix:JR
Gender:M
Credentials:FBPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W MILLBROOK RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4389
Mailing Address - Country:US
Mailing Address - Phone:919-845-9977
Mailing Address - Fax:919-845-9761
Practice Address - Street 1:312 W MILLBROOK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4389
Practice Address - Country:US
Practice Address - Phone:919-845-9977
Practice Address - Fax:919-845-9761
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral