Provider Demographics
NPI:1386756526
Name:TERRACIANO, THOMAS L (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:TERRACIANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 SPRINGFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4119
Mailing Address - Country:US
Mailing Address - Phone:804-747-8300
Mailing Address - Fax:804-747-6215
Practice Address - Street 1:3932 SPRINGFIELD ROAD
Practice Address - Street 2:WEST END FAMILY COUNSELING
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4119
Practice Address - Country:US
Practice Address - Phone:804-747-8300
Practice Address - Fax:804-747-6215
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical