Provider Demographics
NPI:1134435134
Name:COLSTON, SHERI LYNN (PC)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:COLSTON
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-3254
Mailing Address - Country:US
Mailing Address - Phone:484-919-4802
Mailing Address - Fax:
Practice Address - Street 1:200 EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-3254
Practice Address - Country:US
Practice Address - Phone:484-919-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional