Healthcare Provider Details

I. General information

NPI: 1982856910
Provider Name (Legal Business Name): TERRY WAYNE NORTH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8727
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY STE 129
LOUISVILLE KY
40223-5176
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-8779
  • Fax: 606-523-8721
Mailing address:
  • Phone: 502-253-4966
  • Fax: 502-489-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3700
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: