Provider Demographics
NPI:1427206259
Name:JOHNSON, SHERRYL DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHERRYL
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 S BROADWAY ST
Mailing Address - Street 2:P O BOX 65
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1610
Mailing Address - Country:US
Mailing Address - Phone:859-893-0499
Mailing Address - Fax:
Practice Address - Street 1:1219 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2802
Practice Address - Country:US
Practice Address - Phone:859-623-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-19191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical