1508991829 NPI number — MR. TERRY L MASSEY CRTC,LCSW,LISW,CCSOT

Table of content: MR. TERRY L MASSEY CRTC,LCSW,LISW,CCSOT (NPI 1508991829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508991829 NPI number — MR. TERRY L MASSEY CRTC,LCSW,LISW,CCSOT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASSEY
Provider First Name:
TERRY
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRTC,LCSW,LISW,CCSOT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508991829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 178
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT HOLLY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28120-0178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-491-3097
Provider Business Mailing Address Fax Number:
704-625-7129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9635 SOUTHERN PINE BLVD STE 127
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28273-5563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-207-0423
Provider Business Practice Location Address Fax Number:
704-491-3097
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  P002798 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C005677 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6007186 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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