Provider Demographics
NPI:1821366741
Name:CHAPMAN, TERRY LYNN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 MORNINGSTAR LN
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1413
Mailing Address - Country:US
Mailing Address - Phone:304-657-0007
Mailing Address - Fax:
Practice Address - Street 1:207 FAIRMONT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2859
Practice Address - Country:US
Practice Address - Phone:304-363-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009436871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV12332461OtherCAQH