Provider Demographics
NPI:1952679011
Name:SPELLER, TERRY LAMONT SR (LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LAMONT
Last Name:SPELLER
Suffix:SR
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 WILLIAMSTON DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9415
Mailing Address - Country:US
Mailing Address - Phone:252-347-3950
Mailing Address - Fax:252-364-2631
Practice Address - Street 1:482 WILLIAMSTON DRIVE
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9514
Practice Address - Country:US
Practice Address - Phone:252-347-3950
Practice Address - Fax:252-364-2631
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLCASOther2619-A