Provider Demographics
NPI:1790389534
Name:FORD, SHERRY-ANN MARIE STREETE (LSATP, LPC)
Entity Type:Individual
Prefix:
First Name:SHERRY-ANN
Middle Name:MARIE STREETE
Last Name:FORD
Suffix:
Gender:F
Credentials:LSATP, LPC
Other - Prefix:MISS
Other - First Name:SHERRY-ANN
Other - Middle Name:MARIE
Other - Last Name:STREETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSAC
Mailing Address - Street 1:540 E BUTE ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2804
Mailing Address - Country:US
Mailing Address - Phone:757-461-4141
Mailing Address - Fax:757-962-7251
Practice Address - Street 1:540 E BUTE ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2804
Practice Address - Country:US
Practice Address - Phone:757-461-4141
Practice Address - Fax:757-962-7251
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000397101YA0400X
VA0710102685101YA0400X
VA0701008833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)