Provider Demographics
NPI:1841560505
Name:OXENDINE, SHERRY L (LCAS, LCSW)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:OXENDINE
Suffix:
Gender:F
Credentials:LCAS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26280 N TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-9248
Mailing Address - Country:US
Mailing Address - Phone:910-280-0959
Mailing Address - Fax:
Practice Address - Street 1:26280 N TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:WAGRAM
Practice Address - State:NC
Practice Address - Zip Code:28396-9248
Practice Address - Country:US
Practice Address - Phone:910-280-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1898101YA0400X
NCC0110371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)