Healthcare Provider Details

I. General information

NPI: 1992957229
Provider Name (Legal Business Name): SHERRI SHUMAN WILLIS LMFT, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1592 NORMAN DR
VALDOSTA GA
31601-3581
US

IV. Provider business mailing address

2841 N PATTERSON ST
VALDOSTA GA
31602-1743
US

V. Phone/Fax

Practice location:
  • Phone: 229-316-1854
  • Fax:
Mailing address:
  • Phone: 229-316-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW004589
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004381
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT000854
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: