Provider Demographics
NPI:1962616862
Name:SHERRATT, THOMAS (MA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHERRATT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROAD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3579
Mailing Address - Country:US
Mailing Address - Phone:919-286-7500
Mailing Address - Fax:919-493-5798
Practice Address - Street 1:1200 BROAD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3579
Practice Address - Country:US
Practice Address - Phone:919-286-7500
Practice Address - Fax:919-493-5798
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC618103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135 WVOtherBCBS PROVIDER