Healthcare Provider Details

I. General information

NPI: 1023026044
Provider Name (Legal Business Name): DAWN MICHELLE TERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 IRONGATE SQUARE CHESTERFIELD FAMILY GUIDANCE CENTER
RICHMOND VA
23234-6076
US

IV. Provider business mailing address

6603 IRONGATE SQUARE CHESTERFIELD FAMILY GUIDANCE CENTER
RICHMOND VA
23234-6076
US

V. Phone/Fax

Practice location:
  • Phone: 804-743-0960
  • Fax: 804-743-1175
Mailing address:
  • Phone: 804-743-0960
  • Fax: 804-743-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005771
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: