Basic Information
| Provider Information | |||||||||
| NPI: | 1891931770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOSTMAN | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 STAFFORD GREEN WAY | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123154411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 606 WADE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276051390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194432360 | ||||||||
| FaxNumber: | 8188613321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2008 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 1111 | SC | N | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0400X | 1111 | SC | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TA0700X | 1111 | SC | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TB0200X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC2200X | 1111 | SC | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0200X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103TH0004X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TP2701X | 071.007456 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TP2701X | 1111 | SC | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TC0700X | 1111 | SC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.