Healthcare Provider Details

I. General information

NPI: 1083212120
Provider Name (Legal Business Name): SHERRECE D COUSAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HIGHWOODS BLVD STE 310
RALEIGH NC
27604-1029
US

IV. Provider business mailing address

705 BURTON ST
ROCKY MOUNT NC
27803-1904
US

V. Phone/Fax

Practice location:
  • Phone: 919-675-3568
  • Fax:
Mailing address:
  • Phone: 252-419-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018142
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: