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General NPI Number Information
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NPI Number | 1356529846
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Entity Type | Individual
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Provider Name | TERIL DAVIS VIPOND LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 370 9TH ST
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City | CRESCENT CITY
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State | CA
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Zip | 95531-3432
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Country | US
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Telephone | 707-464-4349
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Fax | 707-464-4572
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Provider Business Mailing Address
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Address Line | 14387 HIGHWAY 101 S
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City | BROOKINGS
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State | OR
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Zip | 97415-8322
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Country | US
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Telephone | 541-661-0130
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Fax | 541-469-4317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L3237
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25637
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License Number State | CA
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