Provider Demographics
NPI:1245913656
Name:CHAMPION, TERRI L
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1902
Mailing Address - Country:US
Mailing Address - Phone:941-725-3777
Mailing Address - Fax:
Practice Address - Street 1:8510 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1902
Practice Address - Country:US
Practice Address - Phone:941-725-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral