Provider Demographics
NPI:1104651264
Name:NORWOOD, RICKY TERRELL JR (MED)
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:TERRELL
Last Name:NORWOOD
Suffix:JR
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 HARRISON CREEK BLVD APT 6201
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4789
Mailing Address - Country:US
Mailing Address - Phone:804-861-4884
Mailing Address - Fax:804-862-7188
Practice Address - Street 1:1200 HARRISON CREEK BLVD APT 6201
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4789
Practice Address - Country:US
Practice Address - Phone:804-861-4884
Practice Address - Fax:804-862-7188
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPROV-0660756101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool