Provider Demographics
NPI:1326860404
Name:MURCHINSON, TERA NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:NICOLE
Last Name:MURCHINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-9505
Mailing Address - Country:US
Mailing Address - Phone:912-281-5246
Mailing Address - Fax:
Practice Address - Street 1:218 SCREVEN AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3452
Practice Address - Country:US
Practice Address - Phone:912-281-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1395101YA0400X
GALPC015125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)