Provider Demographics
NPI:1497230999
Name:SHERLING, MARK JASON
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JASON
Last Name:SHERLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 HARBOR LNDG
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3131
Mailing Address - Country:US
Mailing Address - Phone:229-485-7926
Mailing Address - Fax:
Practice Address - Street 1:201 VAUGHN DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2333
Practice Address - Country:US
Practice Address - Phone:770-410-5788
Practice Address - Fax:770-410-4041
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional