Provider Demographics
NPI:1174652549
Name:MCDONNELL, TERENCE (LCMHC)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRIGHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-9577
Mailing Address - Country:US
Mailing Address - Phone:802-649-9099
Mailing Address - Fax:
Practice Address - Street 1:293 MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9344
Practice Address - Country:US
Practice Address - Phone:802-345-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH606101YM0800X
VT0680000672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0680000672OtherMHC
NH606OtherLCMHC