Provider Demographics
NPI:1851643209
Name:SHERRILL, STEPHANIE (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SHERRILL
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 1:217 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2807
Mailing Address - Country:US
Mailing Address - Phone:276-634-8304
Mailing Address - Fax:276-258-6476
Practice Address - Street 1:217 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2807
Practice Address - Country:US
Practice Address - Phone:276-634-8304
Practice Address - Fax:276-258-6476
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9353101YM0800X
VA0701006438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA9353OtherLICENSE NUMBER
VA0701006438OtherLICENSE NUMBER