Provider Demographics
NPI:1861836355
Name:JOHNSON, SHERONDA
Entity Type:Individual
Prefix:
First Name:SHERONDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 STONEOAK CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7307
Mailing Address - Country:US
Mailing Address - Phone:919-498-5724
Mailing Address - Fax:
Practice Address - Street 1:6815 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7080
Practice Address - Country:US
Practice Address - Phone:919-544-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor