Provider Demographics
NPI:1942842521
Name:SHERBOURNE, CATHERINE FAITH (ADC-II, LSWAIC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:FAITH
Last Name:SHERBOURNE
Suffix:
Gender:F
Credentials:ADC-II, LSWAIC
Other - Prefix:
Other - First Name:CAT
Other - Middle Name:FAITH
Other - Last Name:SHERBOURNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16025 SE 250TH CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4168
Mailing Address - Country:US
Mailing Address - Phone:757-291-5765
Mailing Address - Fax:
Practice Address - Street 1:1664 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5201
Practice Address - Country:US
Practice Address - Phone:619-579-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC612770581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical