Provider Demographics
NPI:1245869148
Name:MCKNIGHT, TERRILL (LGPC)
Entity type:Individual
Prefix:
First Name:TERRILL
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 VALLEY COUNTRY CT APT A2
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6186
Mailing Address - Country:US
Mailing Address - Phone:443-529-7140
Mailing Address - Fax:
Practice Address - Street 1:636 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7591
Practice Address - Country:US
Practice Address - Phone:443-529-7140
Practice Address - Fax:443-767-4453
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional