Provider Demographics
NPI:1295871135
Name:ACKESON-MADDEN, SHERRY ELLEN (LMFT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ELLEN
Last Name:ACKESON-MADDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHERIL
Other - Middle Name:ELLEN
Other - Last Name:ACKERSON - MADDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-1484
Mailing Address - Country:US
Mailing Address - Phone:707-964-2378
Mailing Address - Fax:
Practice Address - Street 1:124 E PINE ST
Practice Address - Street 2:FORT BRAGG
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3222
Practice Address - Country:US
Practice Address - Phone:707-964-4376
Practice Address - Fax:707-964-4438
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health