Healthcare Provider Details

I. General information

NPI: 1760575047
Provider Name (Legal Business Name): TERRY J. COCKRELL LPC, CSAC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 OLDE GREENWICH DR
FREDERICKSBURG VA
22408-4063
US

IV. Provider business mailing address

150 OLDE GREENWICH DR
FREDERICKSBURG VA
22408-4063
US

V. Phone/Fax

Practice location:
  • Phone: 540-898-6851
  • Fax: 540-898-6398
Mailing address:
  • Phone: 540-898-6851
  • Fax: 540-898-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710001122
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: