Provider Demographics
NPI:1912962515
Name:DEVLIN, TERRY LEE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LEE
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:BROWNLEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:148 BREAKWATER DRIVE
Mailing Address - Street 2:#410
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-590-6886
Mailing Address - Fax:
Practice Address - Street 1:583 FOREST AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-772-7600
Practice Address - Fax:207-772-7600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
2044418OtherCIGNA
100144OtherANTHEM