Provider Demographics
NPI:1164555751
Name:SHERIFF, JEMSA HAWKEYES
Entity Type:Individual
Prefix:
First Name:JEMSA
Middle Name:HAWKEYES
Last Name:SHERIFF
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 1:144 PARTRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05733-8348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 PARTRIDGE TRL
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:VT
Practice Address - Zip Code:05733-8348
Practice Address - Country:US
Practice Address - Phone:802-247-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000329101YA0400X
VT0680000634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)