Healthcare Provider Details

I. General information

NPI: 1790735850
Provider Name (Legal Business Name): TERRY LEE LEDFORD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N TOMS ST SUITE 1
RUTHERFORDTON NC
28139-2517
US

IV. Provider business mailing address

PO BOX 1131 126 N. TOMS ST, SUITE 1
RUTHERFORDTON NC
28139
US

V. Phone/Fax

Practice location:
  • Phone: 828-286-7967
  • Fax: 828-286-7968
Mailing address:
  • Phone: 828-286-7967
  • Fax: 828-286-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNC0937
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: