Provider Demographics
NPI:1659589430
Name:SHERMAN BERNARD BOONE
Entity Type:Organization
Organization Name:SHERMAN BERNARD BOONE
Other - Org Name:PATH BEYOND POTENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO,THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-623-5502
Mailing Address - Street 1:1220 SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5095
Mailing Address - Country:US
Mailing Address - Phone:919-623-5502
Mailing Address - Fax:
Practice Address - Street 1:607 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2645
Practice Address - Country:US
Practice Address - Phone:919-623-5502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0056691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty