Healthcare Provider Details

I. General information

NPI: 1386157022
Provider Name (Legal Business Name): SHERRY LYNN LANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6999 CARROLLTON PIKE STE 2
GALAX VA
24333-6341
US

IV. Provider business mailing address

770 W RIDGE RD
WYTHEVILLE VA
24382-1187
US

V. Phone/Fax

Practice location:
  • Phone: 276-238-5600
  • Fax:
Mailing address:
  • Phone: 276-223-3222
  • Fax: 276-223-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010186
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: