Provider Demographics
NPI:1801209960
Name:WOOLVERTON, SHERYL WITHERS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:WITHERS
Last Name:WOOLVERTON
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 1:4616 MARCUS TRL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2148
Mailing Address - Country:US
Mailing Address - Phone:859-333-6884
Mailing Address - Fax:
Practice Address - Street 1:4616 MARCUS TRL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2148
Practice Address - Country:US
Practice Address - Phone:859-333-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical