Healthcare Provider Details

I. General information

NPI: 1124200415
Provider Name (Legal Business Name): SHERRY B HURWITZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 N OAK STREET EXT SUITE C
VALDOSTA GA
31602-5909
US

IV. Provider business mailing address

3120 N OAK STREET EXT SUITE C
VALDOSTA GA
31602-5909
US

V. Phone/Fax

Practice location:
  • Phone: 229-671-6140
  • Fax: 229-671-6740
Mailing address:
  • Phone: 229-671-6140
  • Fax: 229-671-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number000111
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: