Provider Demographics
NPI:1538362363
Name:BETHEA, TERRENCE CARTER (MD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:CARTER
Last Name:BETHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 GLENKIRK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9441
Mailing Address - Country:US
Mailing Address - Phone:336-263-5172
Mailing Address - Fax:
Practice Address - Street 1:2054 GLENKIRK DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9441
Practice Address - Country:US
Practice Address - Phone:336-263-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012524492084P0804X
NC2012-019212084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry