Provider Demographics
NPI:1780161711
Name:POE, TERRELL TRE'ON (LCSWA)
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:TRE'ON
Last Name:POE
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 BAXTER ST STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2719
Mailing Address - Country:US
Mailing Address - Phone:919-790-8580
Mailing Address - Fax:704-258-2212
Practice Address - Street 1:2110 ABELWOOD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4202
Practice Address - Country:US
Practice Address - Phone:704-713-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0127131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical