Provider Demographics
NPI:1104469303
Name:MCDONALD, SHERISA RENELL (MA, TLLP)
Entity type:Individual
Prefix:MS
First Name:SHERISA
Middle Name:RENELL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA, TLLP
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Mailing Address - Street 1:2200 BERKLEY AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1763
Mailing Address - Country:US
Mailing Address - Phone:313-646-5802
Mailing Address - Fax:
Practice Address - Street 1:7310 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3165
Practice Address - Country:US
Practice Address - Phone:313-896-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301018120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical