Provider Demographics
NPI:1427103571
Name:TABRON, SHERRY L (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:L
Last Name:TABRON
Suffix:
Gender:F
Credentials:MSW, LCSW
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 54
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0054
Mailing Address - Country:US
Mailing Address - Phone:919-340-0230
Mailing Address - Fax:919-340-0230
Practice Address - Street 1:102 W NASH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2526
Practice Address - Country:US
Practice Address - Phone:919-340-0230
Practice Address - Fax:919-340-0230
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001710104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC185896000OtherMAGELLAN
NC2040129OtherCIGNA
NC10210OtherBLUE CROSS BLUE SHIELD NC
NC367258OtherMHN
NC6002051Medicaid
NC10210OtherBLUE CROSS BLUE SHIELD NC