Provider Demographics
NPI:1083106132
Name:HEARN, SHEREILLA
Entity Type:Individual
Prefix:
First Name:SHEREILLA
Middle Name:
Last Name:HEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 ROBERT C BYRD DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2964
Mailing Address - Country:US
Mailing Address - Phone:304-929-4130
Mailing Address - Fax:304-929-4134
Practice Address - Street 1:3875 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2964
Practice Address - Country:US
Practice Address - Phone:304-929-4130
Practice Address - Fax:304-929-4134
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor