Provider Demographics
NPI:1992957229
Name:WILLIS, SHERRI SHUMAN (LMFT, LMSW)
Entity type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:SHUMAN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LMFT, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1743
Mailing Address - Country:US
Mailing Address - Phone:229-316-2600
Mailing Address - Fax:
Practice Address - Street 1:1592 NORMAN DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-3581
Practice Address - Country:US
Practice Address - Phone:229-316-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000854106H00000X
GACSW0043811041C0700X
GAMSW004589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical