MEDICARE: MRS. GRACHELLE ALYCE SHERBURNE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW004808	GA

General Provider Information

NPI Number	:	1124278577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACHELLE ALYCE SHERBURNE LCSW

Provider Business Mailing Address
First Line	:	5241 CHERRY HILL LN
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-4739
Country	:	US
Telephone Number	:	770-549-6997
Fax Number	:

Provider Business Practice Location Address
First Line	:	5241 CHERRY HILL LN
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-4739
Country	:	US
Telephone Number	:	770-549-6997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	02/08/2013

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