Provider Demographics
NPI:1215580931
Name:JACKSON, SHERRY DANIELLE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:SHERRY
Middle Name:DANIELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 S CLUBVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7041
Mailing Address - Country:US
Mailing Address - Phone:205-657-3137
Mailing Address - Fax:
Practice Address - Street 1:6301 S CLUBVIEW CIR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7041
Practice Address - Country:US
Practice Address - Phone:205-657-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional