Provider Demographics
NPI:1356026306
Name:WALSH, SHERRY AYSCUE (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:AYSCUE
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:132 POPLAR GROVE CONNECTOR STE B
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6121
Practice Address - Country:US
Practice Address - Phone:828-264-8759
Practice Address - Fax:828-264-5754
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0189131041C0700X
NCP0189131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty