Provider Demographics
NPI:1235360264
Name:HAWTHORNE, SHERRY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 COUNTY ROAD 256
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-0420
Mailing Address - Country:US
Mailing Address - Phone:936-569-8132
Mailing Address - Fax:
Practice Address - Street 1:2378 COUNTY ROAD 256
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-0420
Practice Address - Country:US
Practice Address - Phone:936-569-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX037991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108176202Medicaid