Provider Demographics
NPI:1649572587
Name:ONDERICK, TERRENCE LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:LEE
Last Name:ONDERICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 MASSACHUSETTS AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1539
Mailing Address - Country:US
Mailing Address - Phone:202-546-0140
Mailing Address - Fax:
Practice Address - Street 1:1318 MASSACHUSETTS AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1539
Practice Address - Country:US
Practice Address - Phone:202-546-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002583171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator