Provider Demographics
NPI:1174909097
Name:SHERROD, CLARENCE LEE JR (LPC)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:LEE
Last Name:SHERROD
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 COOPER MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8931
Mailing Address - Country:US
Mailing Address - Phone:614-570-1577
Mailing Address - Fax:
Practice Address - Street 1:6530 COOPER MEADOWS RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8931
Practice Address - Country:US
Practice Address - Phone:614-570-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700445101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty