Provider Demographics
NPI:1720367592
Name:SHERIDAN, KEMBERLY SHIOBHAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KEMBERLY
Middle Name:SHIOBHAN
Last Name:SHERIDAN
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 1:9810 MEDLOCK BRIDGE ROAD
Mailing Address - Street 2:BLDG. B, SUITE 101
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-680-4732
Mailing Address - Fax:
Practice Address - Street 1:9810 MEDLOCK BRIDGE ROAD.
Practice Address - Street 2:BLDG. B, SUITE 101
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-680-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002529101YP2500X
GALPC001788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional