Provider Demographics
NPI:1982074597
Name:WITHERSPOON, SHERISE
Entity Type:Individual
Prefix:
First Name:SHERISE
Middle Name:
Last Name:WITHERSPOON
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 1:3501 BON AIRE DR APT 237
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3083
Mailing Address - Country:US
Mailing Address - Phone:318-600-4225
Mailing Address - Fax:318-600-4228
Practice Address - Street 1:3501 BON AIRE DR APT 237
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3083
Practice Address - Country:US
Practice Address - Phone:318-600-4225
Practice Address - Fax:318-600-4228
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor