Provider Demographics
NPI:1033542626
Name:TOLLIVER, CHERIDAN (LICSW, LCSW-C, LCSW)
Entity type:Individual
Prefix:MS
First Name:CHERIDAN
Middle Name:
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:LICSW, LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4657
Mailing Address - Country:US
Mailing Address - Phone:313-580-3689
Mailing Address - Fax:757-766-0160
Practice Address - Street 1:216 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4657
Practice Address - Country:US
Practice Address - Phone:313-580-3689
Practice Address - Fax:757-766-0160
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD179511041C0700X
VA09040110701041C0700X
DCLC500789641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical