Healthcare Provider Details

I. General information

NPI: 1063766871
Provider Name (Legal Business Name): TERRY TORBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 E MAIN ST
NEWARK DE
19711-7311
US

IV. Provider business mailing address

835 SPRINGDALE DR SUITE 100
EXTON PA
19341-2841
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-1504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number500
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: