Provider Demographics
NPI:1487269486
Name:SHERRILL, NICOLE W (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:W
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRANDYWINE DR NE APT J3
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-1822
Mailing Address - Country:US
Mailing Address - Phone:182-823-4619
Mailing Address - Fax:
Practice Address - Street 1:102 BRANDYWINE DR NE APT J3
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-1822
Practice Address - Country:US
Practice Address - Phone:828-234-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0112961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical