Provider Demographics
NPI:1194355081
Name:MCCLANAHAN, SHERRY BOWMAN (LPC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:BOWMAN
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-1083
Mailing Address - Country:US
Mailing Address - Phone:804-216-0110
Mailing Address - Fax:
Practice Address - Street 1:3016 MOUNTAIN RD STE 203
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2051
Practice Address - Country:US
Practice Address - Phone:804-216-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty