Provider Demographics
NPI:1346667474
Name:FLEWELLEN-ERVIN, SHERRY DIANN (LPC,LCDC)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:DIANN
Last Name:FLEWELLEN-ERVIN
Suffix:
Gender:F
Credentials:LPC,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 S BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1515
Mailing Address - Country:US
Mailing Address - Phone:214-622-2713
Mailing Address - Fax:
Practice Address - Street 1:501 WYNNWOOD VILLAGE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-622-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68857101Y00000X
TX7985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)