Provider Demographics
NPI:1295169639
Name:TERRON, ROCHELY (LPC)
Entity type:Individual
Prefix:
First Name:ROCHELY
Middle Name:
Last Name:TERRON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N HOMESTEAD BLVD STE 228
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5024
Mailing Address - Country:US
Mailing Address - Phone:478-919-7879
Mailing Address - Fax:
Practice Address - Street 1:2271 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE ESTATES
Practice Address - State:FL
Practice Address - Zip Code:33855
Practice Address - Country:US
Practice Address - Phone:478-919-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC#008877101YM0800X
GAAPC003605101YM0800X
FLMH15333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003174394AMedicaid
FL022169800Medicaid