Provider Demographics
NPI:1538403910
Name:SHEETS, TINA LANE (LPC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LANE
Last Name:SHEETS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-8896
Mailing Address - Country:US
Mailing Address - Phone:336-372-6083
Mailing Address - Fax:336-372-1930
Practice Address - Street 1:641 CARROLLWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3539
Practice Address - Country:US
Practice Address - Phone:276-728-2070
Practice Address - Fax:276-728-2161
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003110101YP2500X
VA0710101457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional