Provider Demographics
NPI:1770638819
Name:SHERRY ET EL COUNSELING SERVICES
Entity Type:Organization
Organization Name:SHERRY ET EL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TABRON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:919-340-0230
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0054
Mailing Address - Country:US
Mailing Address - Phone:919-340-0230
Mailing Address - Fax:919-340-2300
Practice Address - Street 1:102 W NASH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2526
Practice Address - Country:US
Practice Address - Phone:919-340-0230
Practice Address - Fax:919-340-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001710104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016WHOtherBLUE CROSS BLUE SHIELD NC
NC362112OtherMHN
NC6005188Medicaid
NC016WHOtherBLUE CROSS BLUE SHIELD NC