Provider Demographics
NPI:1982438834
Name:TERRY, KIANA SIMONE (LCSWA)
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:SIMONE
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 STAFFORD FOREST DR APT 202
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6910
Mailing Address - Country:US
Mailing Address - Phone:743-209-1070
Mailing Address - Fax:
Practice Address - Street 1:370 KNOLLWOOD ST STE 301
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1879
Practice Address - Country:US
Practice Address - Phone:336-252-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0212741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical