Provider Demographics
NPI:1184429383
Name:TERRY, CHRISTOPHER DANIEL
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:TERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 KENTBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1163
Mailing Address - Country:US
Mailing Address - Phone:910-331-5209
Mailing Address - Fax:
Practice Address - Street 1:2848 QUEEN CITY DR STE G
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2739
Practice Address - Country:US
Practice Address - Phone:910-331-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0218091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical