Provider Demographics
NPI:1639593403
Name:LUMPKIN, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:LUMPKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:244 COLONIE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2502
Mailing Address - Country:US
Mailing Address - Phone:518-434-4564
Mailing Address - Fax:
Practice Address - Street 1:244 COLONIE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-2502
Practice Address - Country:US
Practice Address - Phone:518-434-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health