Basic Information
| Provider Information | |||||||||
| NPI: | 1548701410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLBROOK | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | KAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 FINDLAY ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403543829 | ||||||||
| FaxNumber: | 7403533083 | ||||||||
| Practice Location | |||||||||
| Address1: | 4350 GALLIA ST | ||||||||
| Address2: | |||||||||
| City: | NEW BOSTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456625515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403546685 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2017 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | QMHS | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 163W00000X | RN.313079 | OH | N | Nursing Service Providers | Registered Nurse | 101YA0400X | LCDCLL.161369 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.