Provider Demographics
NPI:1730951377
Name:KHOURI, SHEREEN (LAPC)
Entity type:Individual
Prefix:
First Name:SHEREEN
Middle Name:
Last Name:KHOURI
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 LISMORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2447
Mailing Address - Country:US
Mailing Address - Phone:706-573-4702
Mailing Address - Fax:
Practice Address - Street 1:1645 HUNTER RD
Practice Address - Street 2:
Practice Address - City:CATAULA
Practice Address - State:GA
Practice Address - Zip Code:31804-2405
Practice Address - Country:US
Practice Address - Phone:706-596-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional