MEDICARE: CHRISTOPHER DANIEL TERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P021809	NC

General Provider Information

NPI Number	:	1184429383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER DANIEL TERRY

Provider Business Mailing Address
First Line	:	625 KENTBERRY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-1163
Country	:	US
Telephone Number	:	910-331-5209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2848 QUEEN CITY DR STE G
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-2739
Country	:	US
Telephone Number	:	910-331-5209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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