Provider Demographics
NPI:1144918202
Name:TERRELL, DANYELLA (LCSW)
Entity type:Individual
Prefix:
First Name:DANYELLA
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18974
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8974
Mailing Address - Country:US
Mailing Address - Phone:601-596-8937
Mailing Address - Fax:
Practice Address - Street 1:1000 TURTLE CREEK DR STE 90
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1165
Practice Address - Country:US
Practice Address - Phone:601-596-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC10562104100000X
LA184881041C0700X
AL5877C1041C0700X
MA1281581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical