Provider Demographics
NPI:1750970315
Name:BUSSANICH, SHERI RENEE
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:RENEE
Last Name:BUSSANICH
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 1:290 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1559
Mailing Address - Country:US
Mailing Address - Phone:828-989-3351
Mailing Address - Fax:
Practice Address - Street 1:290 SCHOOL RD APT A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1559
Practice Address - Country:US
Practice Address - Phone:828-989-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health