Healthcare Provider Details

I. General information

NPI: 1124338470
Provider Name (Legal Business Name): SHERRY THRASHER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3941
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: