Healthcare Provider Details

I. General information

NPI: 1174942478
Provider Name (Legal Business Name): SHERRIE ANDERSON BS, BCPC, MFCT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 BIG POINT RD
MOSS POINT MS
39562-8625
US

IV. Provider business mailing address

3921 BIG POINT RD
MOSS POINT MS
39562-8625
US

V. Phone/Fax

Practice location:
  • Phone: 228-218-6795
  • Fax:
Mailing address:
  • Phone: 228-218-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberBCPC0614
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberSA708302
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: