MEDICARE: MRS. VICKI H TERRY MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003045	NC

General Provider Information

NPI Number	:	1790956092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKI H TERRY MSW, LCSW

Provider Business Mailing Address
First Line	:	547 N FAYETTEVILLE ST
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27203-4725
Country	:	US
Telephone Number	:	336-629-7112
Fax Number	:

Provider Business Practice Location Address
First Line	:	547 N FAYETTEVILLE ST
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27203-4725
Country	:	US
Telephone Number	:	336-629-7112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	10/01/2008

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