Provider Demographics
NPI:1144973157
Name:CHEATHAM, LINDSEY DIANE (LCPC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DIANE
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15965 DORSET RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5312
Mailing Address - Country:US
Mailing Address - Phone:410-474-6931
Mailing Address - Fax:
Practice Address - Street 1:440 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5832
Practice Address - Country:US
Practice Address - Phone:443-792-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCPC9877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health