Provider Demographics
NPI:1518327162
Name:SHERROD, EMMALEE P (LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:EMMALEE
Middle Name:P
Last Name:SHERROD
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 CHERRYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7782
Mailing Address - Country:US
Mailing Address - Phone:336-383-8604
Mailing Address - Fax:
Practice Address - Street 1:3346 CHERRYBROOK DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-7782
Practice Address - Country:US
Practice Address - Phone:336-383-8604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22424101YA0400X
NCA13036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)