Provider Demographics
NPI:1356455935
Name:SHERRILL, KINGA R (LPC)
Entity Type:Individual
Prefix:
First Name:KINGA
Middle Name:R
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1034
Mailing Address - Country:US
Mailing Address - Phone:404-377-9224
Mailing Address - Fax:
Practice Address - Street 1:246 SYCAMORE ST
Practice Address - Street 2:SUITE 240
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3442
Practice Address - Country:US
Practice Address - Phone:404-377-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional