Provider Demographics
NPI:1194873711
Name:WHITESIDE, SHERRY H (LPC, MHSP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:H
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GINGER LN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1826
Mailing Address - Country:US
Mailing Address - Phone:731-441-0835
Mailing Address - Fax:
Practice Address - Street 1:160 GINGER LN
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1826
Practice Address - Country:US
Practice Address - Phone:731-441-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional