Provider Demographics
NPI:1407979966
Name:SHERRICK, SARA ANNE
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ANNE
Last Name:SHERRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25838 COMMONS SQ
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6356
Mailing Address - Country:US
Mailing Address - Phone:703-216-9792
Mailing Address - Fax:
Practice Address - Street 1:102 HERITAGE WAY NE
Practice Address - Street 2:STE. 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-216-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007473Medicaid