Provider Demographics
NPI:1952191090
Name:NORMAN, SHERVONTI (LPC)
Entity type:Individual
Prefix:
First Name:SHERVONTI
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BAYBERRY CT APT A
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-2945
Mailing Address - Country:US
Mailing Address - Phone:618-975-1638
Mailing Address - Fax:
Practice Address - Street 1:322 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2086
Practice Address - Country:US
Practice Address - Phone:618-498-0190
Practice Address - Fax:618-417-6049
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019744101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor