Provider Demographics
NPI:1720098502
Name:HUNT, TERENCE EUGENE (LCMHCS, LCAS)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:EUGENE
Last Name:HUNT
Suffix:
Gender:M
Credentials:LCMHCS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 SILER ST
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-8989
Mailing Address - Country:US
Mailing Address - Phone:336-402-4643
Mailing Address - Fax:
Practice Address - Street 1:250 EXECUTIVE PARK BLVD STE 120
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1534
Practice Address - Country:US
Practice Address - Phone:336-770-2477
Practice Address - Fax:336-962-6739
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS3946101YM0800X, 101YP2500X
NC1146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141F6OtherBCBS
NC6103432Medicaid