Provider Demographics
NPI:1811447683
Name:TERRY, CHARLENE MARIE (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39252 WINCHESTER RD STE 107 491
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3509
Mailing Address - Country:US
Mailing Address - Phone:951-587-1496
Mailing Address - Fax:
Practice Address - Street 1:39252 WINCHESTER RD STE 107-491
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3509
Practice Address - Country:US
Practice Address - Phone:951-587-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70366104100000X, 104100000X
CA943441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker