Provider Demographics
NPI:1912386822
Name:BENJAMIN, SHERRICE (MA, LLPC, CCTP)
Entity Type:Individual
Prefix:
First Name:SHERRICE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MA, LLPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2760
Mailing Address - Country:US
Mailing Address - Phone:313-687-7506
Mailing Address - Fax:
Practice Address - Street 1:13630 PEARSON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2760
Practice Address - Country:US
Practice Address - Phone:313-687-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086712171M00000X
MI6401015065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator