Individual
TERRY WAYNE NORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8727
(606) 523-8779
(606) 523-8721
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(502) 253-4966
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3700
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100289890
—
KY
01
—
P01458985
RR MEDICARE
KY
Enumeration date
10/22/2008
Last updated
12/07/2020
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