Provider Demographics
NPI:1871626986
Name:SOUTHERLAND, TERRI IRELAND (MA, LPA)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:IRELAND
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:IRELAND
Other - Last Name:DULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPA
Mailing Address - Street 1:2032 ELDERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-7876
Mailing Address - Country:US
Mailing Address - Phone:252-955-5425
Mailing Address - Fax:
Practice Address - Street 1:141 STORAGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8561
Practice Address - Country:US
Practice Address - Phone:252-443-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046NOOtherBLUE CROSS BLUE SHIELD