Provider Demographics
NPI:1194892356
Name:SHERRY, THOMAS JUSTIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JUSTIN
Last Name:SHERRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HENDERSONVILLE RD STE 12
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2396
Mailing Address - Country:US
Mailing Address - Phone:828-545-1358
Mailing Address - Fax:
Practice Address - Street 1:30 HENDERSONVILLE RD STE 12
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2396
Practice Address - Country:US
Practice Address - Phone:828-545-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002119Medicaid