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General NPI Number Information
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NPI Number | 1487960712
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Entity Type | Individual
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Provider Name | TERRY D MAXFIELD JR. MA, LCMHC
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Gender | Male
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 289 MAIN ST UNIT B211
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City | NORWICH
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State | VT
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Zip | 05055-9354
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Country | US
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Telephone | 802-526-9958
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 668
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City | NORWICH
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State | VT
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Zip | 05055-0668
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Country | US
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Telephone | 802-526-9958
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068.0057660
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License Number State | VT
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