Provider Demographics
NPI:1407979966
Name:SHERRICK, SARA ANNE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:SHERRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WELTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-1824
Mailing Address - Country:US
Mailing Address - Phone:304-725-7176
Mailing Address - Fax:304-724-1782
Practice Address - Street 1:224 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1824
Practice Address - Country:US
Practice Address - Phone:304-725-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007473Medicaid