Provider Demographics
NPI:1124153069
Name:THOMSON, SHERRY LORRAINE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LORRAINE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1033 WETTERHORN WAY
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-7201
Mailing Address - Country:US
Mailing Address - Phone:508-737-5417
Mailing Address - Fax:
Practice Address - Street 1:1906 S MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5033
Practice Address - Country:US
Practice Address - Phone:195-621-0809
Practice Address - Fax:919-570-3243
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0148401041C0700X
NCC0106371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical