Healthcare Provider Details

I. General information

NPI: 1477361657
Provider Name (Legal Business Name): SHERI GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17024 THE TRAIL
KING AND QUEEN COURT HOU VA
23085-2082
US

IV. Provider business mailing address

PO BOX 211
CENTER CROSS VA
22437-0211
US

V. Phone/Fax

Practice location:
  • Phone: 804-785-6102
  • Fax:
Mailing address:
  • Phone: 804-246-9348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPPS-517430
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: