Provider Demographics
NPI:1124278577
Name:SHERBURNE, GRACHELLE ALYCE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GRACHELLE
Middle Name:ALYCE
Last Name:SHERBURNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 CHERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4739
Mailing Address - Country:US
Mailing Address - Phone:770-549-6997
Mailing Address - Fax:
Practice Address - Street 1:5241 CHERRY HILL LN
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4739
Practice Address - Country:US
Practice Address - Phone:770-549-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0048081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical