MEDICARE: SHALON KALOLE SHERRILL LISW-CP

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	9290	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q489003334	OTHER	SC	MEDICARE PTAN

General Provider Information

NPI Number	:	1538104997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALON KALOLE SHERRILL LISW-CP

Provider Business Mailing Address
First Line	:	500 N MAIN ST STE 4
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6439
Country	:	US
Telephone Number	:	843-871-4790
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N MAIN ST STE 4
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6439
Country	:	US
Telephone Number	:	843-871-4790
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/21/2022

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Directions to “ SHALON KALOLE SHERRILL LISW-CP” Practice Location

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