Provider Demographics
NPI:1558722389
Name:WILSON, SHERRELL (LLPC)
Entity Type:Individual
Prefix:MISS
First Name:SHERRELL
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 WINDING RIDGE DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7564
Mailing Address - Country:US
Mailing Address - Phone:810-606-8438
Mailing Address - Fax:
Practice Address - Street 1:1000 BEACH ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1421
Practice Address - Country:US
Practice Address - Phone:615-828-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional