Provider Demographics
NPI:1033687959
Name:STURGILL, JERRY DWAYNE (LPC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:DWAYNE
Last Name:STURGILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CLAY DR
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-4320
Mailing Address - Country:US
Mailing Address - Phone:276-963-3606
Mailing Address - Fax:276-963-3747
Practice Address - Street 1:220 CLAY DR
Practice Address - Street 2:
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-4320
Practice Address - Country:US
Practice Address - Phone:276-963-3606
Practice Address - Fax:276-963-3747
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health