Healthcare Provider Details

I. General information

NPI: 1790373017
Provider Name (Legal Business Name): SHEENA DAVIDA FORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLGATE DR
CHERRY HILL NJ
08034-1216
US

IV. Provider business mailing address

168 BARCLAY SHOPPING CTR STE 233
CHERRY HILL NJ
08034-2163
US

V. Phone/Fax

Practice location:
  • Phone: 609-200-5878
  • Fax:
Mailing address:
  • Phone: 609-200-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC012752
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: