Healthcare Provider Details

I. General information

NPI: 1679200950
Provider Name (Legal Business Name): TERRELLE N MCCAIN LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SCHOOL ST
BELMONT NC
28012-2123
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-836-9135
  • Fax:
Mailing address:
  • Phone: 704-730-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018070
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: