Healthcare Provider Details

I. General information

NPI: 1104651264
Provider Name (Legal Business Name): RICKY TERRELL NORWOOD JR. M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARRISON CREEK BLVD APT 6201
PETERSBURG VA
23803-4789
US

IV. Provider business mailing address

1200 HARRISON CREEK BLVD APT 6201
PETERSBURG VA
23803-4789
US

V. Phone/Fax

Practice location:
  • Phone: 804-861-4884
  • Fax: 804-862-7188
Mailing address:
  • Phone: 804-861-4884
  • Fax: 804-862-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPROV-0660756
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: