Provider Demographics
NPI:1639570245
Name:SPEEDE-JONES, TERRIE GENEA (MS, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:TERRIE
Middle Name:GENEA
Last Name:SPEEDE-JONES
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HIGHWOODS BLVD ST 310
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1027
Mailing Address - Country:US
Mailing Address - Phone:919-714-7500
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1027
Practice Address - Country:US
Practice Address - Phone:919-532-7599
Practice Address - Fax:919-532-7597
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10444101YM0800X
NC10444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health