Provider Demographics
NPI:1760575047
Name:COCKRELL, TERRY J (LPC, CSAC,)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:J
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:LPC, CSAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OLDE GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4063
Mailing Address - Country:US
Mailing Address - Phone:540-898-6851
Mailing Address - Fax:540-898-6398
Practice Address - Street 1:150 OLDE GREENWICH DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4063
Practice Address - Country:US
Practice Address - Phone:540-898-6851
Practice Address - Fax:540-898-6398
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001122101YA0400X
VA0701002487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA082355OtherSENTARA
VA214991OtherANTHEM HEALTHKEEPERS
VA214991OtherANTHEM BC/BS FEDERAL
VA65340001OtherCARE FIRST BC/BS
VA5409721Medicaid
VA214991OtherANTHEM BC/BS
VA2240716OtherCIGNA
VA352119OtherMAMSI