Provider Demographics
NPI:1720746779
Name:HERRING, ATISHA (LSW)
Entity Type:Individual
Prefix:MS
First Name:ATISHA
Middle Name:
Last Name:HERRING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9565
Mailing Address - Country:US
Mailing Address - Phone:609-471-9874
Mailing Address - Fax:
Practice Address - Street 1:312 E WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9565
Practice Address - Country:US
Practice Address - Phone:609-652-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06331300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker