Provider Demographics
NPI:1174942478
Name:ANDERSON, SHERRIE (BS, BCPC, MFCT, PHD)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BS, BCPC, MFCT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 BIG POINT RD
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-8625
Mailing Address - Country:US
Mailing Address - Phone:228-218-6795
Mailing Address - Fax:
Practice Address - Street 1:3921 BIG POINT RD
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-8625
Practice Address - Country:US
Practice Address - Phone:228-218-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABCPC0614101YP1600X
MSSA708302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral