Healthcare Provider Details

I. General information

NPI: 1033768478
Provider Name (Legal Business Name): DESIREE CHRISTINE TERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 COLDWATER CANYON AVE
NORTH HOLLYWOOD CA
91605-5162
US

IV. Provider business mailing address

PO BOX 2551
NORTH HILLS CA
91393-2551
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-8836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: