Provider Demographics
NPI:1023476553
Name:TERRELL, SUSAN I (CDP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TERRELL
Suffix:I
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4505
Mailing Address - Country:US
Mailing Address - Phone:360-752-3609
Mailing Address - Fax:360-676-2216
Practice Address - Street 1:1400 N FOREST ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4505
Practice Address - Country:US
Practice Address - Phone:360-752-3609
Practice Address - Fax:360-676-2216
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001995101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)