Provider Demographics
NPI:1568031912
Name:AMOS, SHERANDA (MSW,PCAT,PCMHT)
Entity Type:Individual
Prefix:
First Name:SHERANDA
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:MSW,PCAT,PCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-9241
Mailing Address - Country:US
Mailing Address - Phone:601-260-2497
Mailing Address - Fax:
Practice Address - Street 1:1935 LAKELAND DR STE 900
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5028
Practice Address - Country:US
Practice Address - Phone:601-718-2468
Practice Address - Fax:601-718-2487
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA0371101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)