Provider Demographics
NPI:1770826091
Name:THORPE, TERRY JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:JEAN
Last Name:THORPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:THORPE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6239 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3410
Mailing Address - Country:US
Mailing Address - Phone:757-353-0029
Mailing Address - Fax:
Practice Address - Street 1:6239 SHADY LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3410
Practice Address - Country:US
Practice Address - Phone:757-353-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040082041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical