Provider Demographics
NPI:1366632978
Name:SHERWOOD, JAMES (REGGIE) H (CDP)
Entity Type:Individual
Prefix:MR
First Name:JAMES (REGGIE)
Middle Name:H
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-0790
Mailing Address - Country:US
Mailing Address - Phone:509-427-3861
Mailing Address - Fax:509-427-3858
Practice Address - Street 1:683 ROCK CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-0790
Practice Address - Country:US
Practice Address - Phone:509-427-3861
Practice Address - Fax:509-427-3858
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)