Healthcare Provider Details

I. General information

NPI: 1508451071
Provider Name (Legal Business Name): SHERRI LASTER MS,CADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LAUREL LN
BAINBRIDGE GA
39819-6592
US

IV. Provider business mailing address

130 LAUREL LN
BAINBRIDGE GA
39819-6592
US

V. Phone/Fax

Practice location:
  • Phone: 229-254-5546
  • Fax:
Mailing address:
  • Phone: 229-254-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: