Healthcare Provider Details
I. General information
NPI: 1669818811
Provider Name (Legal Business Name): DEENA A TERRELL LCSW, BC-TMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 05/15/2013
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
11357 NUCKOLS RD # 1101
GLEN ALLEN VA
23059-5504
US
IV. Provider business mailing address
11357 NUCKOLS RD # 1101
GLEN ALLEN VA
23059-5504
US
V. Phone/Fax
- Phone: 804-918-5572
- Fax: 888-348-3804
- Phone: 845-200-6685
- Fax: 888-348-3804
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 0904009847 |
| License Number State | VA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 0904009847 |
| License Number State | VA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 44SC05933600 |
| License Number State | NJ |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 44SC05933600 |
| License Number State | NJ |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171000000X |
| Taxonomy | Military Health Care Provider |
| License Number | 0904009847 |
| License Number State | VA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171000000X |
| Taxonomy | Military Health Care Provider |
| License Number | 44SC05933600 |
| License Number State | NJ |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | 0904009847 |
| License Number State | VA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | 44SC05933600 |
| License Number State | NJ |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 222Q00000X |
| Taxonomy | Developmental Therapist |
| License Number | 0904009847 |
| License Number State | VA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 222Q00000X |
| Taxonomy | Developmental Therapist |
| License Number | 44SC05933600 |
| License Number State | NJ |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management Agency |
| License Number | 0904009847 |
| License Number State | VA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management Agency |
| License Number | 44SC05933600 |
| License Number State | NJ |
| # 13 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 0904009847 |
| License Number State | VA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
