Provider Demographics
NPI:1891063798
Name:CRICKENBERGER, TERRY DWIGHT (NP, CNS)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DWIGHT
Last Name:CRICKENBERGER
Suffix:
Gender:M
Credentials:NP, CNS
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Mailing Address - Street 1:1355 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-9146
Mailing Address - Country:US
Mailing Address - Phone:540-332-2142
Mailing Address - Fax:540-332-2209
Practice Address - Street 1:1355 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9146
Practice Address - Country:US
Practice Address - Phone:540-332-2142
Practice Address - Fax:540-332-2209
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0015000523101YM0800X
VA0017139232363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health