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NPI Code Detail

MEDICARE: MS. TERRI IRELAND SOUTHERLAND M.A., L.P.A.

MEDICARE: MS. TERRI IRELAND SOUTHERLAND M.A., L.P.A.
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
1103T00000XPsychologist2253NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1046NOOTHERNCBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1871626986
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TERRI IRELAND SOUTHERLAND M.A., L.P.A.
Provider Business Mailing Address
First Line : 2032 ELDERBERRY CT
Second Line :
City : NASHVILLE
State : NC
Zip : 27856-7876
Country : US
Telephone Number : 252-955-5425
Fax Number :
Provider Business Practice Location Address
First Line : 141 STORAGE RD
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-8561
Country : US
Telephone Number : 252-443-0318
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 10/27/2025

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