Provider Demographics
NPI:1669818811
Name:TERRELL, DEENA A (LCSW, SAP, BC-TMH)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:A
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LCSW, SAP, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 SIENA LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-1114
Mailing Address - Country:US
Mailing Address - Phone:804-918-5572
Mailing Address - Fax:888-348-3804
Practice Address - Street 1:11357 NUCKOLS RD # 1101
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5504
Practice Address - Country:US
Practice Address - Phone:804-918-5572
Practice Address - Fax:888-348-3804
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009847101YA0400X, 101YM0800X, 171000000X, 171M00000X, 222Q00000X, 251B00000X, 1041C0700X, 1041C0700X
NJ44SC05933600101YM0800X, 1041C0700X, 171000000X, 171M00000X, 222Q00000X, 251B00000X
VA48720251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA66016359Medicaid
NJ0738140Medicaid
NJ44SC05933600Medicaid
NJ44SC05933600OtherNEW JERSEY STATE BOARD OF SOCIAL WORK EXAMINERS
VA0904009847Medicaid
VA0904009847OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
VA66016359Medicaid