Provider Demographics
NPI:1861953812
Name:TALLEY, TERRI (LPC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 SAINT ANDREWS RD STE 215
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4500
Mailing Address - Country:US
Mailing Address - Phone:803-626-0712
Mailing Address - Fax:
Practice Address - Street 1:540 SAINT ANDREWS RD STE 215
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4500
Practice Address - Country:US
Practice Address - Phone:803-626-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty