Provider Demographics
NPI:1790735850
Name:LEDFORD, TERRY LEE (PHD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1131
Mailing Address - Street 2:126 N. TOMS ST, SUITE 1
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139
Mailing Address - Country:US
Mailing Address - Phone:828-286-7967
Mailing Address - Fax:828-286-7968
Practice Address - Street 1:126 N TOMS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2517
Practice Address - Country:US
Practice Address - Phone:828-286-7967
Practice Address - Fax:828-286-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04059OtherBCBS
NC6000807Medicaid
NC04059OtherBCBS