Provider Demographics
NPI:1265843940
Name:PRINCE, SHERENA (MS)
Entity Type:Individual
Prefix:
First Name:SHERENA
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 NEW CAMP ROAD
Mailing Address - Street 2:LOT 5
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503
Mailing Address - Country:US
Mailing Address - Phone:606-257-5168
Mailing Address - Fax:606-257-5168
Practice Address - Street 1:70 NEW CAMP ROAD
Practice Address - Street 2:LOT 5
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503
Practice Address - Country:US
Practice Address - Phone:606-257-5168
Practice Address - Fax:606-257-5168
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health