Provider Demographics
NPI:1285855213
Name:CRISP, SHERRIE LYN (CADAC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:LYN
Last Name:CRISP
Suffix:
Gender:F
Credentials:CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 E. PALMDALE BLVD SUITE G
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550
Mailing Address - Country:US
Mailing Address - Phone:661-223-5590
Mailing Address - Fax:661-538-9057
Practice Address - Street 1:1607 E. PALMDALE BLVD SUITE G
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-223-5590
Practice Address - Fax:661-538-9057
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)