=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760575047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY J. COCKRELL LPC, CSAC,
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 OLDE GREENWICH DR
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22408-4063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-898-6851
-----------------------------------------------------
Fax | 540-898-6398
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 OLDE GREENWICH DR
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22408-4063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-898-6851
-----------------------------------------------------
Fax | 540-898-6398
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 0710001122
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701002487
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------