Provider Demographics
NPI:1922378363
Name:JOBIN, TERRANCE RICHARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:RICHARD
Last Name:JOBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5519
Mailing Address - Country:US
Mailing Address - Phone:217-359-7751
Mailing Address - Fax:
Practice Address - Street 1:1723 GEORGETOWN DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5519
Practice Address - Country:US
Practice Address - Phone:217-359-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490013381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149001338OtherLICENSE NUMBER