Healthcare Provider Details

I. General information

NPI: 1437882008
Provider Name (Legal Business Name): MICHAEL JOSEPH TERRY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 WASHINGTON HWY
ASHLAND VA
23005-7646
US

IV. Provider business mailing address

4820 BRUCE RD
CHESTER VA
23831-4215
US

V. Phone/Fax

Practice location:
  • Phone: 804-365-4222
  • Fax: 804-365-4252
Mailing address:
  • Phone: 804-731-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: