Provider Demographics
NPI:1780958116
Name:DAVIS, SHERRIE ANN (CHT)
Entity type:Individual
Prefix:MS
First Name:SHERRIE
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16904 SE 1ST ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8511
Mailing Address - Country:US
Mailing Address - Phone:360-991-2619
Mailing Address - Fax:
Practice Address - Street 1:16904 SE 1ST STREET SUITE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8723
Practice Address - Country:US
Practice Address - Phone:360-991-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHP 60267190103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist