Provider Demographics
NPI:1609409705
Name:EAST, SHERYL TRULUCK (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:TRULUCK
Last Name:EAST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CYPRESS TRAIL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-4355
Mailing Address - Country:US
Mailing Address - Phone:229-412-3127
Mailing Address - Fax:229-482-9653
Practice Address - Street 1:80 CYPRESS TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-5433
Practice Address - Country:US
Practice Address - Phone:229-412-3127
Practice Address - Fax:229-482-9653
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMSW003355OtherLICENSING BOARD OF PSYCHOLOGIST, SOCIAL WORKERS