Provider Demographics
NPI: | 1659782076 |
---|---|
Name: | SHERVINGTON, KEISHA MARIE (LCSW) |
Entity Type: | Individual |
Prefix: | |
First Name: | KEISHA |
Middle Name: | MARIE |
Last Name: | SHERVINGTON |
Suffix: | |
Gender: | F |
Credentials: | LCSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 6350 W ANDREW JOHNSON HWY DEPT 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | TALBOTT |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37877-8605 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-355-3565 |
Mailing Address - Fax: | 423-714-2355 |
Practice Address - Street 1: | 501 ADESA BLVD STE A150 |
Practice Address - Street 2: | |
Practice Address - City: | LENOIR CITY |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37771-6719 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-986-8082 |
Practice Address - Fax: | 865-986-5890 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-05-20 |
Last Update Date: | 2020-11-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X | ||
TN | LSW7466 | 1041C0700X |
TN | LSW10402 | 104100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker |