Provider Demographics
NPI:1396118139
Name:GATEWOOD, SHERITA
Entity type:Individual
Prefix:
First Name:SHERITA
Middle Name:
Last Name:GATEWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 UNION AVENUE EXT STE 610
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4422
Mailing Address - Country:US
Mailing Address - Phone:901-458-4000
Mailing Address - Fax:901-458-0048
Practice Address - Street 1:2670 UNION AVENUE EXT STE 610
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4422
Practice Address - Country:US
Practice Address - Phone:901-458-4000
Practice Address - Fax:901-458-0048
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health