Provider Demographics
NPI:1215941935
Name:TODD, SHERRY MALANA (LPC, ATR, CTS)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:MALANA
Last Name:TODD
Suffix:
Gender:F
Credentials:LPC, ATR, CTS
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 1555
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-9555
Mailing Address - Country:US
Mailing Address - Phone:757-635-3394
Mailing Address - Fax:757-425-4461
Practice Address - Street 1:117 W 21ST ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2246
Practice Address - Country:US
Practice Address - Phone:757-635-3394
Practice Address - Fax:757-425-4461
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010195527Medicaid