| Doctor Name: | MR. REGINALD CHARLES TERRY |
| NPI Number: | 1023279841 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, LLPC, CAADC |
| License Number: | 6401011111 |
| Business Practice Address: | 35031 23 Mile Rd New Baltimore, MI - 480473649 |
| Business Phone Number: | 5867255777 |
| Business Fax Number: | 5867254099 |
| Mailing Address: | 35031 23 Mile Rd, NEW BALTIMORE |
| State: | MI |
| Postal Code: | 480473649 |
| Phone Number: | 5867255777 |
| Fax Number: | 5867254099 |
| NPI Enumeration Date: | 06/24/2008 |
| NPI Last Update Date: | 02/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401011111 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |