Provider Demographics
NPI:1306377825
Name:VANFOSSAN, SHERRY (LISW-CP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:VANFOSSAN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 E MCBEE AVE
Mailing Address - Street 2:UNIT 314
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2775
Mailing Address - Country:US
Mailing Address - Phone:732-245-8505
Mailing Address - Fax:
Practice Address - Street 1:98 E MCBEE AVE
Practice Address - Street 2:UNIT 314
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2775
Practice Address - Country:US
Practice Address - Phone:732-245-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical