Provider Demographics
NPI:1932131034
Name:NEVINS, TERRI (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:
Last Name:NEVINS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 VALLEY FORGE WAY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2706
Mailing Address - Country:US
Mailing Address - Phone:410-599-7400
Mailing Address - Fax:410-671-4708
Practice Address - Street 1:1432 VALLEY FORGE WAY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2706
Practice Address - Country:US
Practice Address - Phone:410-599-7400
Practice Address - Fax:410-671-4708
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD077051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD086YMedicare ID - Type Unspecified