Provider Demographics
NPI:1194046276
Name:CRIMM, TERRY L (DMIN; LMFT; LPC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:CRIMM
Suffix:
Gender:M
Credentials:DMIN; LMFT; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 EDGEWATER WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6953
Mailing Address - Country:US
Mailing Address - Phone:803-548-6155
Mailing Address - Fax:
Practice Address - Street 1:1021 MAXWELL MILL RD
Practice Address - Street 2:SUITE D-2
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8093
Practice Address - Country:US
Practice Address - Phone:803-548-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1642101YP2500X
NC613101YP2500X
SC1865106H00000X
NC566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional