Provider Demographics
NPI:1902079676
Name:SHERROD-BYNUM, DOROTHY L (CRC, LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:SHERROD-BYNUM
Suffix:
Gender:F
Credentials:CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 EAGLE FARM DR N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1274
Mailing Address - Country:US
Mailing Address - Phone:252-291-3176
Mailing Address - Fax:252-291-1101
Practice Address - Street 1:3646 EAGLE FARM DR N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1274
Practice Address - Country:US
Practice Address - Phone:252-291-3176
Practice Address - Fax:252-291-1101
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional