Healthcare Provider Details

I. General information

NPI: 1770790537
Provider Name (Legal Business Name): SHERRY LANE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 CONSTITUTION AVE NE
WASHINGTON DC
20002-6202
US

IV. Provider business mailing address

922 CONSTITUTION AVE NE
WASHINGTON DC
20002-6202
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-5230
  • Fax:
Mailing address:
  • Phone: 202-546-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT000015
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: