Healthcare Provider Details

I. General information

NPI: 1962800094
Provider Name (Legal Business Name): SHERRI STINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MICHIGAN AVE
ALLARDT TN
38504-0026
US

IV. Provider business mailing address

PO BOX 26
ALLARDT TN
38504-0026
US

V. Phone/Fax

Practice location:
  • Phone: 931-879-7198
  • Fax:
Mailing address:
  • Phone: 931-879-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5897
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5897
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerLCSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: