Healthcare Provider Details

I. General information

NPI: 1801910930
Provider Name (Legal Business Name): TERRY D. KENT MA , NCC , LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 BRANSCOME YOUNG RD
DANBURY NC
27016-7721
US

IV. Provider business mailing address

1164 BRANSCOME YOUNG RD
DANBURY NC
27016-7721
US

V. Phone/Fax

Practice location:
  • Phone: 336-593-2798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1071
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: