Provider Demographics
NPI:1639106370
Name:KETNER, SHERYL NORRIS (LPC)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:NORRIS
Last Name:KETNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CAROLINA ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1032
Mailing Address - Country:US
Mailing Address - Phone:336-272-1200
Mailing Address - Fax:336-272-1182
Practice Address - Street 1:1301 CAROLINA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1032
Practice Address - Country:US
Practice Address - Phone:336-272-1200
Practice Address - Fax:336-272-1182
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102159Medicaid
NC1204ROtherBCBS
NC0005484079OtherAETNA